Presentation

1. BWALYA K

2.  Upper respiratory tract infections are caused
by viruses and bacteria.
 Most infections – coryza (common cold),
pharyngo-conjuctival feveer, acute laryngits
and acute laryngobronchitis are caused by
viruses.
 However superinfection with bacteria may
occur especially Streptococcus pyogenes and
Staphylococcus pyogenes

3. Aetiological agent Clinical syndrome Incubation period
Adenoviruses Acute coryza
Pharngoconjuctival fver
Acute laryngitis
6-9 days
Coxsackie virus Pharyngoconjuctival fever
Herpangiana
7-14 days
Echo viruses Acute coryza
Pharyngoconjuctival fever
2-4 days
Influenza virus A, B, (C) Epidemic influenza
Acute
laryngotracheobronchitis
(croup)
1-3 days
Parainfluenza virus 1-4 Acute coryza
Acute
laryngotracheobronchitis
4- 7 days

4.  Acute laryngotracheal Bronchitis
 Acute Epiglottitis
 BacterialTracheitis
 This infections result in upper airway
obstruction at the supraglottic, glottic and
subglottic levels
 Thus stridor is a major clinical feature

6.  Hypoxia
 Acute upper airway obstruction
 Feeding problems
 Increasing tachycardia, tachypnoea,
restlessness or apathy indicates the need for
urgent intervention to maintain the airway

7.  Is the commonest cause of stridor in children
 Causes include parainfluenza, adenoviruses,
RSV, influenza viruses, measles
 History
 Onset - gradual

8.  LTB also called croup is the most common
form of acute upper airway obstruction
 Primary findings are inflammatory oedema,
destruction of ciliated epithelium and
exudates
 Most patients have an upper respiratory tract
infection for several days before cough
becomes apparent

9.  Initially there is only a mild brassy cough with
intermittent stridor
 As obstruction increases, stridor becomes
continuous and is associated with worsening
cough, nasal flaring and suprasternal,
infrasternal and intercostal recessions.
 As inflammation extends to the bronchi and
bronchioles, respiratory difficulty increases
 Stridor becomes continuous, cough worsens,
expiratory phase of respiration also becomes
labored and prolonged

10.  Temperature may only be slightly raised.
Rare to reach 39-40 centigrade
 Agitation and crying worsens the symptoms
and signs
 Child prefers to sit up in bed or be held
upright

11.  On examination:
 There may be bilaterally diminished breath
sounds, ronchi and scattered crackles
together with stridor
 AS airway obstruction worsens, air hunger
and restlessness occurs
 The patient then develops severe hypoxemia,
hypercapnia and weakness accompanied by
decrease air exchange and stridor,
tachycardia and eventually death

12.  In the hypoxemic chid who may be cyanotic
or pale, any manipulation of the pharynx may
result in sudden cardio respiratory arrest.This
examination therefore is deferred until the
patient is in a hospital where there is optimal
 Airway management and expertise for
possibly doing tracheostomy by ENT
surgeon.
 Intubation are usually done in the presence of
an anaesthetist and ENT surgeon

13.  Stridor should be treated as a medical emergency.
 All attempts should be made to abort it as quickly as
possible
 Patient must be nursed in propped up position
 Intravenous Steroids e.g. dexamethasone 0.3mg/kg
given 8 hourly until stridor is comfortably aborted and
breathing is normal. Normally 48-36 hours. ( Some
schools of thought believe and one dose only, but
chances of recurrence of stridor high). If
dexamethasone is not available, hydrocortisone may
be used except is not as potent.

14.  Inhaled steroids (budesonide – not yet available)
 Nebulised racemic epinephrine – (2.25% diluted
1:8 with water or normal saline or 1:1000 diluted
with normal saline 1:9 in doses of 2-4mls for 15
minutes gives temporary but almost immediate
relief. May have to be repeated
 Humified oxygen or steam often helps to
terminate attack
 Oxygen

15.  This is swelling of the epiglottis and
aryepiglottic folds causing a rapid onset of
symptoms
 Causes:
 H. Influenza
 Streptococci
 Viral

16.  History
 Age 3-7 years usually
 Onset rapid
 Respiratory distress marked

17.  Dysphagia moderate
 Dyspnoea severe
 Sorethroat marked

18.  Sound muffled
 Secretions drooling saliva
 Position sitting or leaning forward
 Fever >38
 Facies anxious

19.  Avoid throat examination
 Expert anaesthetic and ENT should be sought
immediately
 And laryngoscopy and intubation should be
performed
 Iv antibiotics: crystalline penicillin and
chloramphenicol
 Prophylaxis for household contact

20.  Affects all ages
 Causative organisms;
 Staphylococcal aureus
 H. Influenza
 Alpha H. streptococci

21.  Gradual onset of symptoms
 Respiratory disease is moderate to marked
 Signs:
 Dysphagia may or may not be
present
 Dyspnoea usually present moderate

22.  Sore throat may or not be present
 Sounds barking cough, and stridor
 Secretions normal for age
 Position sitting or leaning forward
 Fever > 38
 Facies anxious