The document discusses various infectious upper airway obstructions, focusing on conditions such as tonsilopharyngitis, croup, epiglottitis, and bacterial tracheitis. It outlines the etiology, epidemiology, clinical presentation, diagnosis, management, and potential complications for each condition. The prognosis is generally favorable with prompt and appropriate treatment, especially for conditions like epiglottitis and croup.

1. Infectious Upper Airway Obstruction
Tonsilopharyngitis
Laryngotracheobronchitis
Epiglottitis
Bacterial tracheaitis
Dr Alemseged [MD]
March 2015

2. Tonsilopharyngi
tis
 Approximately ⅓ Upper respiratory
tract infections feature a sore throat
and painful on swallowing as the
primary symptom.
Etiology
 Viral and GABHS(most common causes
– GAS accounts for 15 to 30 percent of all cases of
pharyngitis in children between the ages of 5
and 15 years

3. Epidemiolog
y
 Viral upper respiratory tract infections
are spread by close contact
 Streptococcal pharyngitis is uncommon
before 2–3 yr of age, has a peak
incidence in the early school years, and
declines in late adolescence and
adulthood.
 Illness occurs most often in winter and
spring and spreads among siblings and
classmates.

4. Pathogenes
is
 Colonization of the pharynx by
GABHS can result in either
asymptomatic carriage or acute
infection.
 The M protein is the major virulence
factor of GABHS and facilitates
resistance to phagocytosis

5. Clinical presentation
Rapid onset with prominent sore throat
& fever
Headache and GI symptoms are
common
A viral etiology is suggested by the
presence of conjunctivitis, coryza,
hoarseness, and cough.
Onset of viral pharyngitis has more
insidious onset

6. Diagnosi
s
 Clinical
 Throat swab culture
 Rapid antibody tests

7. Management
 Symptomatic Mx with anti-pyretics,
analgesics, local anesthetics
 Antibiotic therapy should be started
immediately without culture for children with
symptomatic pharyngitis
 Untreated cases un evenly improve but early
antibiotic therapy hastens clinical recovery by
12–24 hr and prevents ARF
 Penicillin v or amoxicillin for 10 days
 Erythromycin (if allergic to the above drugs)
 Clindamycin and Azithromycin clear carriers
 Tonsilectomy is indicated in children with
recurrent culture +ve pharyngitis that has been
sever and frequent(7 in one year or 5/year for
to consecutive years)

8. Complicatio
ns
 Otitis media
 Local supperative complications like -
parapharyngial abscess
-retropharyngeal
absess
 ARF
 AGN

9. Physical examination
 Pharynx is red &tonsils are enlarged &
classically covered with yellow blood
tinged exudates
 Uvula is red and swollen
 Doughnut lesions or petechae on the soft
palate and posterior pharynx
 Tender and swollen ant. cervical nodes
 Some may manifest with Scarlet fever-
circumoral pallor, strawberry tongue &red
and finely papular rash that feels like
sandpaper & with goose pimples

10. CROUP
[Laryngeotracheobronchitis]
Introduction
 Minor reduction in cross sectional area
due to mucosal edema or other
inflammatory processes cause an
exponential increase in air way resistance
 The cricoid cartilage defines the
narrowest portion of the upper air way in
a child <10yrs
Definition
 Croup refers to a heterogeneous group
of mainly acute and infectious process
that are characterized by bark like or

11. Etiology
Para influenza virus(types 1,2,3)-75%
of cases
---but only small amount develop overt croup---
Influenza(A &B)
Adenovirus
RSV
 measles virus
Rarely mycoplasma pneumonae

12. Epidemiolo
gy
 Age 3 months up to 5years
 Peak is 2nd
year of life
 Males are more frequently affected
 Common in winter season
 Recurrence common till 3-6yrs and
decreases with age

13. Clinical
presentation
 Most common cause of upper resp.
tract obstruction
 Pts. usually have rhinorrhea,
pharyngitis, mild cough & low grade
fever 1-3 days prior to symptom of UAO
like
 Stridor
 Barking cough
 Hoarsness
 Respiratory distress
 Sms resolve with in a week
 Other Fx members may have mild resp.
illness

14. Physical
examination
 Assumes sniffing potion
 Hoarse voice
 Normal to moderately inflamed pharynx
 Signs of respiratory distress.
When complete airway obstruction is
imminent
 Hypoxia and low oxygen saturation
 Cyanotic
 Pale
 Obtunded
needs immediate airway management-
tracheostomy

15. Diagnosis
Mainly based on classic clinical
presentation
PA CXR – Steeple sign

16. Complication
Seen in 15% of patients
 Otitis media
 Bacterial tracheatis
 Bacterial pneumonia
 Cervical lymphadenitis
 Mediastinal emphysema
 pneumothorax

17. Croup
score

18. Management

19. Management
cont’d
Dexamethasone 0.6mg/kg IM stat
Racemic epinephrine is administered as 0.05
mL/kg per dose (maximum of 0.5 mL) of a 2.25
percent solution diluted to 3 mL total volume
with normal saline. It is given via nebulizer over
15 minutes.
L-epinephrine is administered as 0.5 mL/kg per
dose (maximum of 5 mL) of a 1:1000 dilution. It
is given via nebulizer over 15 minutes.
Heliox also similar effect as epinephrine
Antibiotics not indicated

20. Spasmodic croup
 Similar to croup but no fever & usually occurs
b/n 1-3 years of age
 Cause is usually allergy
 Self limiting with in hours
 Familial tendency
 Unlike classic croup pt is well between episodes
and degree of recurrence is high and
symptoms worse at night
 Like classic croup mist,steroids and nebulized
epinephrine may have benefit but pts go out of
symptoms once brought for medical attention

21. Epiglottitis
• Epiglottitis is inflammation of the
epiglottis and adjacent supraglottic
structures

22. Etiology
Infectious causes
 Hib (not common cause in westerns)
 Strept. pyogens, S. pneumonea, S.aureus
 Other forms of hemophilus influenza [A,F and nontypable]
 Immunocompromised hosts Pseudomonas aeruginosa
and Candida species.
Non-infectious causes
 Thermal injury
 Foreign body ingestion, and
 Caustic ingestion
 Epiglottitis also may rarely occur as a complication of bone
marrow or solid organ transplantation

23. Epidemiology
 1st
year to 7th
year
 Peak 6-36 months

24. Clinical presentation
 Acute fulminating course with toxic
apperance high fever, sore throat, dyspnea
&rapidly progressing resp. obstrn.
 Abrupt onset and rapid progression (within
hours) of
 Dysphagia
 Drooling
 Distress
("the three D's") are hallmarks of epiglottitis in children
 Air hunger, restlessness, cyanosis & finally
coma

25. Tripod positioning

26. Diagnosis
 Laryngoscope-large cherry red epiglottis
 If Dx is certain or probable laryngoscope should be done
in the OR or ICU.
 Blood culture

27. Diagnosis
cont’d
• Lateral neck x ray - features
• An enlarged epiglottis protruding from
the anterior wall of the hypopharynx
(the "thumb sign“

28. Manageme
nt
 Airway securing is the main stay
Endotracheal tube or tracheostomy
 Iv Abcs for 7-10 days(ceftriaxone or
cefotaxime)
 Oxygen supplementation
 Racemic epinephrine and
corticosteroids are ineffective

29. Chemoprophylaxis
• Rifampin prophylaxis (20 mg/kg orally
once a day for 4 days; maximum dose,
600 mg) should be given to all
household members if there is one
contact younger than 48 mo of age who
is incompletely immunized or if there is
an immunocompromised child in the
household.

30. Complicatio
ns
Airway obstruction — occurs
unpredictably at any point
 Epiglottic abscess
 Secondary infection — Secondary
infection (eg, pneumonia, cervical
adenitis, cellulitis, septic arthritis, and
meningitis)
 Necrotizing epiglottitis — rare
complication in patients with
immunodeficiency

31. Bacterial tracheitis
Bacterial tracheitis is an exudative
bacterial infection of the soft tissues
of the trachea
Etiology
 S.aureus(most common)
 M.catarrhalis,non typable H.influ.
&anaerobic organisms

32. Epidemiolog
y
 Most are less than 3 years
 No sex predilection
 Usually follows viral infections

33. Clinical
presentation
Brassy cough, high grade fever and
Pt will be toxic
No drooling, no dysphagia
No response to usual Rx of croup
Major pathologic feature is mucosal
swelling at the level of the cricoid
cartilage complicated by copious
thick, purulent secretions sometimes
causing pseudo membranes

34. Diagnosis
 Mainly clinical
 Suctioning of pus
 X-ray: rough & ragged tracheal outline
Management
 Artificial air way & oxygen
 Abcs containing anti staph. Regimen

35. Complication
 Cardioresp. Arrest
 Pneumonia
 Toxic shock syndrome
Prognosis
 Is excellent for most patients
 Usually improves in 2-3 days with Abcs

36. Prognosis
In general, the length of hospitalization and
the mortality rate for cases of acute infectious
upper airway obstruction increase as the
infection extends to involve a greater portion
of the respiratory tract, except in epiglottitis
Untreated epiglottitis has a mortality rate of
6% in some series, but with appropriate
management the prognosis is excellent.
The outcome of acute
laryngotracheobronchitis, laryngitis, and
spasmodic croup is also excellent.
Most deaths from croup are caused by a
laryngeal obstruction or by the complications

37. Thank you !!