UPPER RESPIRATORY TRACT INFECTION

Dr Sarika Gupta (MD,PhD); Asst. Professor

1. Croup 2. Epiglottitis 3. Bacterial tracheitis 4. Acute infectious laryngitis 5. Spasmodic croup 6. Common Cold 7. Otitis Media 8. Sinusitis 9. Pharyngitis/Tonsillitis

CROUP

Laryngotracheobronchitis Early childhood viral syndrome Most common age group is 3m – 5years , peak in

2nd year Boys Winter season The parainfluenza viruses (type 1, 2 and 3)

account for 75% others – influenza A, B , adenovirus , measles ,

RSV, rhinovirus, coronavirus and human metapneumovirus.

CROUP

Rhinorrhoea, pharyngitis, mild cough and low grade fever for 1-3 days followed by characteristic barking cough, hoarseness and inspiratory stridor

Symptoms are more during the early hours of morning

Symptoma are genrally short lived Examination – inlamed pharynx , increased

respiratory rate , nasal flaring , stridor , suprasternal, infrasternal , intercostal retraction

Diagnosis – clinical CXR shows typical subglottic stenosis or steeple

sign

CROUP

CROUP

Differential diagnosis: 1. Reteropharyngeal or peritonsillar abscess 2. Angioneurotic edema 3. Allergic reaction 4. Foreign body 5. Laryngeal diphtheria

CROUP

Treatment: 1. Reduce agitation 2. Airway management 3. Treatment of hypoxia- BLOW by oxygen 4. Single dose of 0.6mg/kg of oral / im

dexamethasone 5. Nebulised epinephrine

EPIGLOTTITIS

SUPRAGLOTTITIS Potentially life –threatening infection of the

supraglottic structures Abrupt onset Fulminating course of high fever, toxic

appearance, sore throat, dysnoea and rapidly progressive respiratory obstruction

Within hours, swallowing becomes difficult and breathing is labored

Drooling is present and child assumes a tripod position

EPIGLOTTITIS

Stridor is a late finding Breathing becomes noisy, and the voice and cry

are muffled

EPIGLOTTITIS

Organisms – Hemophilus influenza type b -most common. Incidence has decreased due to use of vaccine

Others – streptococcus pyogenes , streptococcus pneumonia and staphylococcus aureus

The diagnosis requires visualization of a large cherry red swollen epiglottis by laryngoscopy. But laryngoscopy should be performed in an intensive care unit

Anxiety provoking interventions should be avoided until the airway is secure

EPIGLOTTITIS

Lateral x ray of neck shows thumb sign

Treatment – establishing an airway by nasotracheal intubation or by tracheostomy with iv antibiotics

BACTERIAL TRACHEITIS

Acute bacterial infection of upper airway Life threatening Often a complication of viral croup Most common organism – staphylococcus aureus Children with bacterial tracheitis tend to be older

compared with those with viral croup High fever , toxicity with respiratory distress Diagnosis – clinical, purulent material is noted

below the cords during endotracheal intubation

BACTERIAL TRACHEITIS

Treatment: 1. establishing an airway by nasotracheal

intubation or by tracheostomy 2. Antibiotics Complications: toxic shock syndrome, septic

shock, post intubation pulmonary edema, ARDS and subglottic stenosis

Summary

The differential diagnosis for stridous breathing should include croup, epiglottitis and bacterial tracheitis

Most patients with croup can be managed as outpatients with corticosteroids

If epiglottitis is suspected, the child should be admitted

Children who have croup tend to have sudden onset of hoarseness and barking cough, but do not appear toxic, as compared to those who have epiglottitis and bacterial tracheitis