INTRODUCTION In developing countries, 12 million children die in t he first year of life. 19% of the deaths are due to ARI % of ARI deaths occur in less than 2 months of age % occur in infants. Very few deaths occur in children 1-4 years of age. Severity of pneumonia is high in developing countries. 25% of out pt visits 15% of all hospital admissions

AURI Common cold, otitis media, pharyngitis & sinusitis. ALRI Croup-Epiglottis, laryngitis and laryngotracheitis. Bronchitis Bronchiolitis Pneumonia ARI include all the above conditions which are of<30days duration except Ac.otitis media which is <14daysduration.

UPPER RESPIRATORY TRACT INFECTIONS Structures above larynx- nasal cavity, throat, nasopharynx, ears & sinuses. Common causes of morbidity. ACUTE NASOPHARANGITIS Commonest condition in children 5-8 episodes/year –highest in 1 st 2years ofage because of number of exposures in nursery schools and day care centers. Increase susceptibility –poor nutrition. Aetiology- caused by >200 viruses Corona viruses-10% Rhino viruses

Common cold-Congestion, swelling and increase secretions of nasopharyngeal mucosa. In infants and young children-more distressing nasal discharge, nasal block, dry cough and conjunctival congestion may be complicated by Sinusitis and otitis media. Excessive crying even after-Otitis media treatment. Prolonged course of cold-Sinusitis. Treatment-Self limiting, no treatment required. Symptomatic treatment- Cough-home remidies-Tulsi,gnger and honey. CLINICAL FEATURES

Acute infections of pharynx and tonsils. Pharangitis-involvement of the throat. Uncommon<1year of age. Peak incidence at 4-7years there after throughout childhood and adult life. Associated with rhinitis, sinusitis and occasionally laryngitis. Aetiology- caused by viruses-Rhino,corono,influenza,para influenza and adeno viruses % of sore throat-Gr.A.Beta haemolytic streptococci. Mycoplasma.

CLINICAL FEATURES Fever, sore throat, malaise, anorexia, pain during deglutition, nasal discharge, conjunctival congestion and some discomfort in the throat. Enlarged congested tonsils and exudates over pharynx, tonsils and palate. Enlarged tonsils and soreness-blockade of oropharynx-to poor intake. Ant. cervical lymphnodes-enlarged occasionally drooling of saliva present. Complications- Viral-Self limiting Streptococcal-Suppurative complications like peritonsillar abscess and retropharyngeal abscess.

Non Suppurative Complications Rh.Fever and Ac.Glome.Nephritis Identification of streptococcal infection Beefy red tonsils, tonsillar pillars, exudates petechae on tonsils, uvula and soft palate. Cervical lymphadenitis with absence of nasal discharge. Diagnosis- Detection of streptococcal antigens. Throat culture

TREATMENT Viral-No specific treatment. Streptococcal- Penicillin for 10days. Amoxycillin-40mg -50mg/kg.tid Erythromycin-30-40mg/kg.tid Sore throat-Ibuprofen, Salt water gargling

Complication of Bacterial pharyngitis. Less commonly-Extension from vertebral osteomyelitis. Common pathogens are-Streptococci, oral anaerobes and St. aureus. High grade fever, severe dysphagia, refusal of feeds, severe distress with throat pain, noisy often gurgling respirations. Drooling of saliva-difficulty in swallowing. Bulge in the post. Pharyngeal wall or around tonsils is usually apparent. Cannot be detectable by simple inspection. Clinical features

Lateral X-ray of the neck- Retropharyngeal space is wider than the C4 vertebral body. If untreated ruptures into the pharynx. Death may be due to aspiration, airway obstruction or mediastinitis. Treatment Surgical drainage under GA. Analgesics and antibiotics.

Acute infectious laryngo tracheobronchitis Aetiology -Viral-parainfluenza 1 and 2 types Clinical features -6m-3years of age. Symptoms of URTI and lasts for 5 days. A brassy cough inspiratory strider and respiratory distress. Signs of upper air way block- Labored breathing, suprasternal, sub costal and inter costal retractions. Associated with lower air way disease-Wheezing with productive cough.

X-ray- Steeple sign -It is a narrowed subglotic space which is caused by edema. Treatment- Nebulize with epinephrine. In severe cases repeat every 20minutes. Keep the child calm. Humidified oxygen Systemic Steroids are beneficial. Sudden worsening signs-fever, respiratory distress and leukocytosis suggests complicated bacterial tracheitis.

Ethmoid-developed at birth. Maxillary-rudimentary at birth and visible on X-ray at 6months. Sphenoid-3-4years Frontal Sinus-6-11years Maxillary and ethmoidal sinuses are more involved when muco cilliary clearance and drainage are impaired. Clinical Ethmoiditis- Not occurs at the age of 6months. Presents like periorbital cellulitis. Causative Organisms are Streptococcal Pneumonia, H-influenza, M.Catarrhalis-beta haemolytic Streptococci. Immuno Compromised Children-gram negative bacteria and fungi.

Clinical features Fever, tenderness over sinuses, thick purulent nasal discharge. Infants-Periorbital puffiness Older Children-Headache, post nasal discharge and persistent cough at night. Complications- Epidural or subdural abscess, meningitis, cavernous sinus thrombosis, orbital or periorbital cellulitis and abscess. Diagnosis- X-ray of paranasal sinuses-Air fluid levels and complete opacification with mucosal thickening. CT scan/MRI-Immunocompromised patients or incomplicated patients.

Treatment Antibiotics Amoxicillin, Co-trimaxazole, Ampicillin or Amox with clavulanate or second or third generation cephalosporins. Supportive care-Fever care, nasal drops.