Acute respiratory infections in the developing world

Publisher Website
Google Scholar
Abstract
Substantial reduction of the still unacceptable infant and child mortality rates in the developing world will be difficult to achieve without a strategy to avert deaths due to acute respiratory infections (ARI). An estimated 2 to 5 million infant and childhood deaths each year are due to ARI; up to 98% might be prevented if case-fatality ratios could be reduced to those observed in the industrialized world. However, the heterogeneity of clinical presentations and causative organisms has hampered efforts to address this leading cause of death among children. The classification and management of ARI in the industrialized world is founded upon radiologic and microbiologic data, in addition to the clinical history and physical examination. ARI syndromes, which are complex clinical conditions of varying etiology and severity, have been categorized primarily on the basis of anatomical location. Common diagnostic categories for uncomplicated ARI with etiologic and clinical correlates are detailed in Table 1. Although acute upper respiratory infections, such as the common cold, are of great public health importance due to their high incidence, only the acute lower respiratory infections such as pneumonia and bronchiolitis are major causes of mortality. Although little is known about the incidence and etiologies of respiratory illnesses in developing countries, the available data suggest that more than 75% of ARI deaths are caused by pneumonia, both bacterial and viral. Bacterial pneumonias, which account for the majority of deaths due to ARI in the developing world, remain the most treatable of causes of severe ARI. They may also become, with emerging vaccine technologies, preventable. This review focuses primarily on the prevention and treatment of the bacterial pneumonias in less developed countries.