UPPER RESPIRATORY TRACT INFECTION

1. UPPER RESPIRATORY TRACT INFECTION Dr Sarika Gupta (MD,PhD); Asst. Professor

2. 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

3. 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.

4. 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

5. CROUP

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

7. 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

8. 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

9. EPIGLOTTITIS • Stridor is a late finding • Breathing becomes noisy, and the voice and cry are muffled

10. 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

11. EPIGLOTTITIS • Lateral x ray of neck shows thumb sign • Treatment – establishing an airway by nasotracheal intubation or by tracheostomy with iv antibiotics

12. 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

13. 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

15. 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