UPPER RESPIRATORY TRACT INFECTIONS peadiatrics.pptx

paediatric upper respiratory tract infections

1. UPPER RESPIRATORY TRACT INFECTIONS DR. CHIKONDE

2. COMMON COLD OR CORYZA Common cold is a frequent illness in childhood and is usually caused by infections of the upper respiratory tract with adenoviruses, influenza, rhinovirus, parainfluenza or respiratory syncytial viruses. These are spread by droplet infection. Predisposing factors include chilling, sudden exposure to cold air and overcrowding. Rhinitis could also be due to allergy.

3. CLINICAL FEATURES Fever T hin nasal discharge and irritability. Cervical lymph nodes may enlarge. Nasopharyngeal congestion causes nasal obstruction and respiratory distress. D ry hacking cough.

4. TREATMENT Relieve nasal congestion. Nose drops of saline may give symptomatic relief. Nasal decongestants (ephedrine, xylometozoline) may cause rebound congestion. These should not be used routinely and used only in refractory cases for limited duration. Antihistaminics are best avoided in the first six months of life. Nonsedating agents, e.g. loratidine and cetirizine may be used in allergic rhinitis. Fever is controlled by antipyretics such as paracetamol (acetaminophen). Cough syrups should not be given. Antibiotics are of little value in viral infections. These are used if the secretions become purulent, the fever continues to rise and if the child develops bronchopneumonia.

5. COMPLICATIONS otitis media Laryngitis Sinusitis Bronchiolitis exacerbation of asthma and bronchopneumonia

6. ACUTE OTITIS MEDIA Risk factors: Eustachian tube obstruction by adenoids or inflammatory edema in upper respiratory infection Causes Viral Bacterial: pneumococci, haemophilus influenza, Moraxella catarrhalis, streptococci Clinical picture Fever, Severe earache (irritability & rubbing the ears in infants). Relieved after drum perforation. Otoscopic examination: drum is congested, bulging or perforated ± discharge. Complications: Mastioditis (tender swelling behind the ear) Chronic ear infection (draining ears for 14 days or more Treatment) Symptomatic for pain & fever(paracetamol). A ntibiotics for 10 days amoxycillin or cotrimoxazole 2"d or 3rd generation cephalosporins. Surgical: myringotomy & drainage rarely needed.

7. TONSILLITIS Tonsillitis , or inflammation of the tonsils, is a common disease and makes up approximately 1.3% of outpatient visits. It is predominantly the result of a viral or bacterial infection and, when uncomplicated, presents as a sore throat. Viral causes ( rhinovirus , respiratory syncytial virus, adenovirus, and coronavirus, Epstein-Barr (causing mononucleosis), cytomegalovirus, hepatitis A, rubella, and HIV ). Bacterial causes ( group A beta- hemolytic Streptococcus (GABHS), Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenza, In unvaccinated patients, Corynebacterium diphtheriae )

8. CLINICAL FEATURES Fever Malaise Headache Nausea sore throat Hoarseness , cough and rhinitis are common in viral infection. In streptococcal infections, cervical Lymph nodes are enlarged and illness is more acute with high fever, exudates over tonsillar surface and absence of nasal discharge or conjunctivitis. Young children may not complain of sore throat, but refuse to feed normally.

9. EPIGTOTTITIS including epiglottitis and inflammatory edema of the hypopharynx, is caused chiefly by Haemophilus influenza type b.

10. High fever. D ifficulty in swallowing. The child is not able to phonate. S its up leaning forwards with his neck extended and saliva dribbling from his chin Accessory muscles of respiration are active and there is marked suprasternal and subcostal retractions. T he epiglottis is angry red and swollen.

11. TREATMENT Patients with epiglottitis need hospitalization. Humidified oxygen is administered by hood. As oxygen therapy masks cyanosis, watch is kept for impending respiratory failure. Sedatives should not be used. Fluids are administered for adequate hydration by IV route. Third generation cephalosporins (cefotaxime, ceftriaxone 100 mg/kg/ day) is recommended for patients with epiglottitis. Endotracheal intubation or tracheostomy may be required, if response to antibiotics is not adequate and obstruction is worsening

12. LARYNGOTRACHEOBRONCHILITIS (INFECTIOUS CROUP) Almost always caused by viral infections, chiefly parainfluenza type 1. Other viruses include RSV, parainfluenza types 2 and 3, influenza, adenovirus and rhinovirus . The onset of illness is gradual with cold for few days before the child develops brassy cough an d inspiratory stridor. As obstruction increases , the stridor is marked; suprasternal and sternal recessions become manifest. The child becomes restless and anxious with tachypnea due to increasing hypoxemia. Eventually cyanosis appears. As obstruction worsens breath sounds are inaudible and stridor may apparently decrease.

13. TREATMENT Patients with laryngotracheobronchitis should be assessed for severity of illness based on general appearance , stridor (audible with/without stethoscope), oxygen saturation and respiratory distress Mild cases can be managed as OPD with symptomatic treatment for fever and encouraging the child to take liquids orally Moderately severe patient require hospitalization and treatment with epinephrine (1:1000 dilution 0.1-0.5 mL/kg; maximum 5 mL) administered through nebulizer for immediate relief of symptoms. S ingle dose of dexamethasone (0.3-0.6 mg/kg IM) within the first 24 hours. Severe croup requires urgent hospitalization with oxygen inhalation, therapy with epinephrine and steroids (as above), and occasionally short-term ventilation