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Shah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
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O iginal Resea ch A icle
Cu en Clinical P o iles o Acu e Respi a o y T ac In ec ions in Child en
be ween 2 Mon hs o 5 Yea s
Bha i Shah1, Ha shida Vagadoda2, Sachin Pa el3
1,2,3Assis an P o esso , Depa men o Pedia ics, Banas Medical College & Resea ch Ins i u e, Palanpu ,
Guja a , India
Recei ed: 01-06-2025 Re ised: 15-07-2025 / Accep ed: 21-08-2025
Co esponding au ho : D . Sachin Pa el
Con lic o in e es : Nil
Abs ac
Backg ound: Acu e espi a o y ac in ec ions (ARTIs) a e among he leading causes o childhood mo bidi y
and mo ali y wo ldwide, especially in child en aged 2 mon hs o 5 yea s. Thei clinical spec um a ies om
mild uppe espi a o y ac in ec ions o se e e lowe espi a o y in ol emen .
Aim: To delinea e he espi a o y disease p o iles o child en aged 2 mon hs o 5 yea s p esen ing wi h ARTIs.
Ma e ial and Me hods: A hospi al-based obse a ional c oss-sec ional s udy was conduc ed including 120
child en aged 2 mon hs o 5 yea s wi h clinical ea u es o ARTI. De ailed demog aphic da a, p esen ing
complain s, and clinical diagnoses we e eco ded. Da a we e analyzed o de e mine he dis ibu ion o uppe and
lowe espi a o y ac in ec ions.
Resul s: Nasopha yngi is (34.2%) was he mos common condi ion, ollowed by pneumonia (14.2%) and
b onchioli is (10.8%). Fe e , cough, and cold we e he p edominan p esen ing complain s. Less equen
condi ions included sinusi is, onsillopha yngi is, c oup, and epiglo i is. Male child en we e sligh ly mo e
a ec ed (55%) compa ed o emales (45%).
Conclusion: ARTIs in unde - i e child en emain a majo public heal h conce n, wi h nasopha yngi is,
pneumonia, and b onchioli is as he mos equen diagnoses. Ea ly ecogni ion, accina ion, and access o
diagnos ic ools a e c ucial o imp o ing ou comes and educing he disease bu den.
Keywo ds: Acu e espi a o y ac in ec ions, Child en unde i e, Pneumonia, B onchioli is.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Acu e espi a o y ac in ec ions (ARTIs) emain
among he mos pe asi e and bu densome
illnesses in ea ly childhood, pa icula ly a ec ing
child en aged 2 mon hs o 5 yea s, du ing a c i ical
phase o immune and espi a o y ac de elopmen
[1]. Globally, ARTIs accoun o subs an ial
mo bidi y and mo ali y wi hin his age g oup,
o en leading o epea ed ou pa ien isi s, hospi al
admissions, and in se e e cases, dea h—
highligh ing he p essing need o unde s and hei
clinical p o iles [2].
In de eloping coun ies such as India, ARTIs
con ibu e o nea ly one- hi d o pedia ic
ou pa ien consul a ions and an e en la ge
p opo ion o pedia ic hospi al admissions, placing
conside able s ain on al eady cons ained
heal hca e sys ems [3]. A ecen egional c oss-
sec ional analysis om Wes e n Maha ash a
epo s ha uppe espi a o y ac in ec ions
(URTIs)—no ably nasopha yngi is and
onsillopha yngi is—p edomina ed (60%), while
lowe espi a o y ac in ec ions (LRTIs) such as
pneumonia and b onchioli is a ec ed close o 45%
o child en aged 2 mon hs o 5 yea s [4]. In a
simila hospi al-based case se ies om Biha , 200
child en aged 2 mon hs o 5 yea s wi h acu e lowe
espi a o y ac in ec ions e ealed no only
clinical p esen a ions bu also ou comes closely ied
o ea ly diagnosis and managemen [5].
Eme ging su eillance-based insigh s unde sco e
ha i al pa hogens a e p ima y d i e s o ARTIs
in child en unde i e. In Cabo Ve de,
comp ehensi e molecula diagnos ics iden i ied
espi a o y i uses as he main causa i e agen s,
wi h clinical p esen a ion and isk ac o s closely
linked o socio-demog aphic and en i onmen al
a iables [6]. B oade epidemiological modeling
indica es ha he leading pa hogens include
adeno i uses, in luenza, human hino i us, and
Mycoplasma pneumoniae, each exe ing a
signi ican bu den on pedia ic heal h se ices
wo ldwide [7]. A ecen i ology s udy epo ed
ha espi a o y syncy ial i us (RSV) alone
accoun ed o app oxima ely 43% o i al
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Shah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
111
espi a o y ac in ec ions in unde - i e child en,
unde sco ing i s o e whelming impac [8]. Mo e
de ailed su eillance sys ems, such as ha in Egyp ,
con i m he c ucial impo ance o acking
in luenza and RSV ends o in o m imely clinical
and public heal h esponses [9]. In addi ion,
e ol ing global su eillance highligh s ha i uses
such as human me apneumo i us (hMPV)— he
second mos common cause o ARTI in ou pa ien
child en unde i e—a e gaining ecogni ion as
signi ican con ibu o s o he pedia ic ARTI
bu den [10].
Agains his backd op, he cu en s udy aimed o
comp ehensi ely delinea e he clinical p o iles o
acu e espi a o y ac in ec ions in child en aged 2
mon hs o 5 yea s, he eby in o ming clinicians and
public heal h p ac i ione s on p edominan disease
pa e ns and acili a ing op imized managemen
s a egies.
Ma e ial and Me hods
The p esen s udy was designed as a hospi al-based
obse a ional c oss-sec ional s udy conduc ed in
he Depa men o Pedia ics o a e ia y ca e
eaching hospi al o e a pe iod o wel e mon hs. A
o al o 120 child en be ween he ages o 2 mon hs
and 5 yea s who p esen ed wi h symp oms
sugges i e o acu e espi a o y ac in ec ion we e
en olled. E hical app o al was ob ained om he
Ins i u ional E hics Commi ee p io o ini ia ion o
he s udy, and w i en in o med consen was aken
om pa en s o legal gua dians o all pa icipan s.
Child en aged 2 mon hs o 5 yea s wi h clinical
ea u es o acu e espi a o y ac in ec ion,
including cough, e e , nasal discha ge, achypnea,
espi a o y dis ess, o auscul a o y abno mali ies,
we e included in he s udy. Exclusion c i e ia
comp ised child en wi h known congeni al hea
disease, immunode iciency diso de s, ch onic lung
disease, se e e malnu i ion, o hose who had
ecei ed an ibio ics o an i i al d ugs wi hin 48
hou s p io o p esen a ion. De ailed demog aphic
and clinical da a we e collec ed using a
p edesigned p o o ma, which included age, sex,
nu i ional s a us, socioeconomic backg ound,
his o y o p esen illness, and pas medical his o y.
Clinical examina ion was pe o med wi h emphasis
on espi a o y a e, p esence o ches ind awing,
use o accesso y muscles, auscul a o y indings,
oxygen sa u a ion, and p esence o sys emic
in ol emen . An h opome ic measu emen s we e
eco ded o assess nu i ional s a us. In es iga ions
we e pe o med as indica ed and included comple e
blood coun , C- eac i e p o ein, ches adiog aphy,
and pulse oxime y. Vi al diagnos ic assays such as
apid an igen de ec ion o espi a o y syncy ial
i us and in luenza we e ca ied ou whe e e
easible. Child en we e ca ego ized clinically in o
uppe espi a o y ac in ec ions, including
nasopha yngi is, pha yngi is, onsilli is, and o i is
media, and lowe espi a o y ac in ec ions,
including pneumonia, b onchioli is, and b onchi is,
based on clinical and adiological indings.
The sample size o 120 was selec ed o ensu e
adequa e ep esen a ion o bo h uppe and lowe
espi a o y ac in ec ion p o iles in he s udy
popula ion. Da a we e compiled and coded
sys ema ically. S a is ical analysis was pe o med
using SPSS so wa e e sion XX. Con inuous
a iables we e exp essed as mean ± s anda d
de ia ion and compa ed using S uden ’s - es o
Mann–Whi ney U es as app op ia e. Ca ego ical
a iables we e exp essed as p opo ions and
compa ed using Chi-squa e es o Fishe ’s exac
es . A p- alue o less han 0.05 was conside ed
s a is ically signi ican .
Resul s
In his s udy, he demog aphic dis ibu ion o
child en aged 2 mon hs o 5 yea s wi h acu e
espi a o y ac in ec ions is summa ized in Table
1. The majo i y o he cases we e seen in he age
g oup o 0–1 yea (41.7%), ollowed by 1–2 yea s
(20.0%). The p opo ion o child en g adually
dec eased wi h inc easing age, wi h he leas cases
being obse ed in he 4–5 yea age g oup (5.8%).
The mean age dis ibu ion shows ha younge
child en a e disp opo iona ely mo e a ec ed. Male
child en cons i u ed a sligh ly highe p opo ion o
cases (55.0%) compa ed o emales (45.0%),
indica ing a mild male p eponde ance.
Rega ding p esen ing complain s, e e was he
mos equen symp om, wi h 55.8% o child en
p esen ing wi h i , while 17.5% had e e as he
p edominan complain . Abou 15.8% o child en
epo ed only mild e e and 10.8% had no e e .
Cough was p esen in 74.2% o child en, and in
10.0% i was he p edominan ea u e, while only
15.8% had no cough. Cold was epo ed in 80.8%
o cases, while b ea hlessness was no ed in 7.5% o
child en. Ches pain was uncommon, seen in less
han 1% o he cases. So e h oa was p esen in
12.0% o child en, and sinus ende ness was no ed
in jus 3.3%. The inal clinical diagnosis e ealed
ha nasopha yngi is (34.2%) was he mos
common condi ion, ollowed by pneumonia
(14.2%) and b onchioli is (10.8%), as shown in
Table 1. O he condi ions included wheeze-
associa ed lowe espi a o y in ec ion (9.6%),
onsillopha yngi is (6.7%), and nasopha yngi is
wi h pneumonia (9.2%). Less equen diagnoses
we e sinusi is, onsilli is, pleu i is, c oup, and
epiglo i is, which oge he cons i u ed less han
10% o he o al cases. These indings e lec ha
acu e espi a o y ac in ec ions in his age g oup
p edominan ly mani es as nasopha yngeal
in ec ions, wi h a signi ican p opo ion also
p esen ing as lowe espi a o y ac in ol emen .
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Shah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
112
Table 1: Summa y o di e en a iables (N=120)
Va iables
Sub-ca ego y
Numbe o pa ien s N (%)
Age (yea s)
0–1
50 (41.7)
1–2
24 (20.0)
2–3
15 (12.5)
3–4
10 (8.3)
4–5
7 (5.8)
Gende
Female
54 (45.0)
Male
66 (55.0)
Complain s
Fe e absen
13 (10.8)
Fe e mild
19 (15.8)
Fe e p edominan
21 (17.5)
Fe e p esen
67 (55.8)
Cough absen
19 (15.8)
Cough p edominan
12 (10.0)
Cough p esen
89 (74.2)
Cold absen
23 (19.2)
Cold p esen
97 (80.8)
B ea hlessness absen
111 (92.5)
B ea hlessness p esen
9 (7.5)
Ches pain absen
119 (99.2)
Ches pain p esen
1 (0.8)
So e h oa absen
105 (87.5)
So e h oa p esen
15 (12.5)
Sinus ende ness absen
116 (96.7)
Sinus ende ness p esen
4 (3.3)
Condi ion
B onchioli is
13 (10.8)
C oup
4 (3.3)
Epiglo i is
1 (0.8)
Nasopha yngi is
41 (34.2)
Nasopha yngi is + pneumonia
11 (9.2)
Nasopha yngi is + sinusi is
1 (0.8)
Pleu i is
1 (0.8)
Pneumonia
17 (14.2)
Pneumonia + sinusi is
3 (2.5)
Sinusi is
4 (3.3)
Tonsilli is
2 (1.7)
Tonsillopha yngi is
8 (6.7)
Tonsillopha yngi is + pneumonia
2 (1.7)
Wheeze-associa ed lowe espi a o y in ec ion (WALRI)
12 (10.0)
Discussion
The p esen s udy highligh s ha acu e espi a o y
ac in ec ions (ARTIs) con inue o cons i u e a
signi ican heal h p oblem among child en aged 2
mon hs o 5 yea s, wi h nasopha yngi is,
pneumonia, and b onchioli is eme ging as he
leading condi ions. The p edominance o uppe
espi a o y ac in ec ions, pa icula ly
nasopha yngi is, is consis en wi h ecen global
and egional indings which sugges ha i al
e iologies a e he p incipal con ibu o s o pedia ic
espi a o y illness. A mul icen ic Asian
su eillance p ojec iden i ied hino i us, RSV, and
in luenza as he mos equen pa hogens in his age
g oup, wi h clinical p esen a ions o e lapping
conside ably be ween URTIs and LRTIs [11]. The
high p opo ion o pneumonia obse ed in his
s udy unde sco es he pe sis ing bu den o lowe
espi a o y ac in ec ions in unde - i e child en.
Recen es ima es om sub-Saha an A ica and
Sou h Asia ea i m pneumonia as he leading
cause o in ec ious mo ali y in his age g oup,
despi e he in oduc ion o pneumococcal and Hib
accines [12]. In ou coho , pneumonia o en
p esen ed concu en ly wi h nasopha yngi is,
e lec ing he con inuum om mild uppe ac
illness o se e e lowe ac in ol emen .
B onchioli is and wheeze-associa ed lowe
espi a o y in ec ions accoun ed o nea ly one- i h
o he clinical diagnoses. RSV emains he
dominan i al pa hogen associa ed wi h
b onchioli is globally, and epidemiological models
sugges seasonal peaks con ibu e subs an ially o
pedia ic hospi al admissions [13]. This ein o ces
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Shah e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
113
he impo ance o ea ly ecogni ion and suppo i e
managemen in in an s, who emain mos
ulne able o se e e disease.
In e es ingly, condi ions such as c oup, epiglo i is,
and sinusi is we e ela i ely uncommon in ou
s udy, e lec ing he impac o imp o ed
accina ion co e age and ea ly in e en ions.
Howe e , eme ging e idence sugges s ha i al
c oup associa ed wi h pa ain luenza and in luenza
i uses emains spo adically signi ican ,
pa icula ly in he pos -pandemic pe iod whe e
i al ci cula ion pa e ns ha e shi ed [14].
The clinical spec um obse ed in ou s udy also
aligns wi h global su eillance da a ha emphasize
he impo ance o i al diagnos ics in
di e en ia ing be ween o e lapping synd omes o
ARTI. Rapid poin -o -ca e es ing, hough no
uni e sally a ailable in low- and middle-income
coun ies, has been shown o educe unnecessa y
an ibio ic p esc ibing and imp o e case
managemen in pedia ic popula ions [15]. Hence,
in eg a ing diagnos ic inno a ions wi h obus
clinical e alua ion emains a co ne s one in
ackling ARTI in young child en.
Conclusion
The indings o his s udy demons a e ha ARTIs
in child en aged 2 mon hs o 5 yea s a e
p edominan ly due o nasopha yngi is, pneumonia,
and b onchioli is, wi h e e , cough, and cold being
he mos common p esen ing complain s. While
uppe espi a o y ac in ec ions p edomina e, he
subs an ial p opo ion o pneumonia and
b onchioli is highligh s he con inued ele ance o
lowe espi a o y in ol emen in his age g oup.
S eng hening p e en i e s a egies, ensu ing
imely accina ion, and expanding access o
diagnos ic ools a e essen ial o educe mo bidi y.
Ea ly ecogni ion and ailo ed managemen can
signi ican ly al e ou comes and help alle ia e he
bu den o ARTI in unde - i e child en.
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