Croup syndrome( diptheria,acute epiglottitis,aryngotracheobronchitis)

incidence,classification and manaement at primary health care level

1. Croup Syndrome

2. Croup Group of diseases Acute onset Infectious etiology Characterized by Brassy cough Stridor: inspiratory Hoarseness Respiratory distress

3. Croup Laryngotracheobronchitis Spasmodic croup Acute epiglottitis Diphtheretic croup Bacterial tracheitis

4. Laryngotracheobronchitis Most common form of acute respiratory obstruction Viral: Parainfluenzae (1,2,3) Influenzae A, B Adeno, RSV, Measles

5. Laryngotracheobronchitis Age group: 3 mon-5yr Peak age 2 yr Male>>female Common in winter F/H + [15%]

6. Clinical features Preceded by symptoms of URI Rhinorrhoea Mild cough Low grade fever Barking cough Hoarseness Inspiratory stridor

7. Clinical features Worsening of symptoms: during night Relieved by Crying Sitting up/ upright posture

8. Investigation Xray neck: Steeple sign Narrowing in subglottic area

9. TREATMENT CORTICOSTEROIDS EPINEPHRINE MAINTAIN ABC

10. Acute Epiglottitis Supraglottitis Medical emergency Caused by Hemophilous influenzae type b

11. Clinical features Usually starts with minor respiratory symptoms Rapid progression High fever Hoarseness Stridor Resp. distress : retractions Difficulty in swallowing Drooling of saliva Hyperextended neck

12. Clinical features Laryngoscopy: “angry red” epiglottis Epiglottis : large & inflamed Precaution: Laryngoscopy/ throat examination should be done only in controlled environment In presence of Equipments for securing airway Experienced personnel

13. Investigation X- ray neck (Lat view) Thumb sign

14. TREATMENT MAINTAIN AIRWAY: TRACHEOSTOMY MAY BE REQUIRED ( REFER IMMEDIATELY AS SOON AS DIAGNOSED SEVERE) BREATHING: O2 BY MASK OR OXYGEN HOOD ADEQUATE HYDRATION AVOIDANCE OF PAINFUL PROCEDURES(LARYNGOSCOPY) ANALGESICS SPECIFIC NTIBIOTICS FOR GRAM NEG COVERAGE

15. DIPHTHERIA

16. Clinical features DIPHTHERIC CROUP Sore throat Hoarseness Stridor Brassy cough Toxic look, ill looking Lack of fever

17. Clinical features Pseudomembrane Leather like membrane Off-white or greyish and semitransparent Adherent, bleeding on attempt of removal Extension beyond faucial structures Presence of respiratory obstruction

18. DIAGNOSIS

19. Management General management Mild disease: no hospitalization Oral antibiotics: penicillin ,erythromycin Analgesics, antipyretics Counselling about risk factors to parents Diptheric croup : Oxygen- mask/ tent Maintain airway patent Avoid painful procedures Refer if features of respiratory distress Artificial airway (if reqd.) [ Tracheostomy / intubation] Diphtheria (with evidence of resp obstruction)

20. Adequate hydration Analgesics / antipyretics Cutaneous lesions: Wound care debridement and cleaning and dressing

21. Management Specific management Crystalline penicillin Anti Diphtheretic Serum

22. prevention Immunization: As pentavalent vaccine at 6,10,14 weeks of life Isolation of cases and carriers

23. Thank you