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.  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