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1. THE MINISTRY OF HEALTH AND SANITATION OF
SIERRA LEONE
SCHOOL OF CLINICAL SCIENCES MAKAMBO-MAKENI.
 TOPICS: 1. CROUP
2. MUMPS
 LECTURERS:
-DR AMADU JALLOH
 GROUP SIX (6)
PRESENTATION

2. GROUP MEMBERS
NO. NAMES ID NO.
1 ABEL KOMBA SANDI 20045
2 RITA K KAMARA 20027
3 MOHAMED KAPRIE CONTEH 20009
4 PETER SIMON NEYMAR KARGBO 20034

3. OUTLINE
 Definition
 Etiology
 Epidemiology
 Pathogenesis
 Transmission
 Clinical features
 Lab investigation
 Treatment
 Complications
 Differential diagnosis
 Prevention
 Summary

4. CROUP: BACKGROUND
• DEFINITION:
CROUP is an upper airway infection that blocks
breathing and has a distinctive barking cough.
Also called laryngotracheobronchitis (LTB).
Peak onset is in children 2 years of age.
Primarily occurs in late fall and early winter.
Very low mortality but high morbidity.
About 5% of children have had at least one episode
of croup; and 5% of them have a second episode.

5. CROUP: ETIOLOGY
Most often caused by parainfluenza virus.
Also caused by RSV, influenza A and B and
other organisms.
Rarely: Mycoplasma Pneumoniae, herpes, and
measles virus have been reported as causes.

6. EPIDEMIOLOGY
 Peak fall & winter.
 Range primarily 1-6 years
 Incidence 5/100 of children between age 1-2
years
 Males > females

7. CROUP: PATHOPHYSIOLOGY
Inflammation may occur in both the upper
and lower airways.
Subglottic swelling produces stridor when soft
tissues collapse during the negative pressure
of inspiration.
Narrowing of the upper airway by 1 mm
reduces the cross-section by 50% in 2 yr old.

8. CROUP: PATHOPHYSIOLOGY (CONT.)
Inflammation of the lower airways can lead to
V/Q mismatching and hypoxemia.
Large increases in the WOB are common.
Decreases in ventilation are not common in
mild to moderate cases; may occur with
severe fatigue.

9. CROUP: CLINICAL PRESENTATION
 History of recent upper
airway infection.
 Now develop barking
cough, hoarseness, and
stridor.
 Low grade fever
common
 Symptoms often
increase at night.
 Physical examination
helps identify the
severity.
 Tachypnea, nasal flaring,
retractions and use of
accessory muscles are
common.
 CBC often normal, if
done.

10. LAB INVESTIGATIONS
 Radiographic findings (Neck X-Ray)
 CT-scan
 Pulse oximetry
 Recurrent croup:
 Bronchoscopy- done by chest physician/ surgeon.

11. CROUP: RADIOGRAPHIC FINDINGS
Normal in many cases of croup.
Decision to obtain neck film can be difficult
and is often done only in more severe cases
and when Epiglottitis is suspected.
Subglottic narrowing is seen with croup.
Complications such as pneumonia should be
looked for when high fever and leukocytosis
are present.

12. CROUP: RADIOGRAPHIC FINDINGS
CONT.

13. Normal Trachea
Trachea with Croup
“Steeple Sign”

14. CROUP: SIGNS OF A MORE SEVERE
CASE
Stridor at rest or I and E stridor.
 Inspiratory retractions.
Severe tachypnea (>60 b/min).
Heavy use of accessory muscles.
Abnormal sensorium.
Age less than 4 months.
Poor response to treatment.
Restlessness, anxiety and sweating.

15. Inspiratory stridor:
Not present - 0 points.
When agitated/active - 1 point.
At rest - 2 points.
Intercostal recession:
Mild - 1 point.
Moderate - 2 points.
Severe - 3 points.
Air entry:
Normal - 0 points.
Mildly decreased - 1 point.
Severely decreased - 2 points.
Cyanosis:
None - 0 points.
With
agitation/activity -
4 points.
At rest - 5 points.
Level of
consciousness:
Normal - 0 points.
Altered - 5 points.
The modified Westley clinical scoring
system for croup
Possible score 0-17: <4 = mild croup, 4-6 = moderate
croup, >6 =severe croup

16. CROUP: TREATMENT
 Humidity therapy is the first line of treatment and
improves symptoms in most cases.
 Racemic epinephrine; rapid acting but does not change
length of illness.
 Steroids:
 controversial and reserved for severe cases
(Dexamethasone 0.6 mg/kg).
 Heliox decreases the WOB; used as an adjunct.
 Adrenaline- nebulised adrenaline (2mg STAT) Adrenalin
5mls of 1:1000.
0.4mg/kg max 5mg. Duration of action is b/w 20min and
3hrs. Contraindicated in tetralogy of fallots.

17. COMPLICATIONS
Hypoxemia and respiratory failure.
Pulmonary edema.
Pneumothorax and pneumomediastinun.
Lymphadenitis.
Otitis media.
Secondary bacteria infections.
Bacterial tracheitis.
Bronchopneumonia and pneumonia.
Cardiac arrest and death.

18. DIFFERENTIAL DIAGNOSIS
Airway foreign body.
Diphtheria.
Inhalation injury.
Laryngomalacia.
Mononucleosis and epstein - barr virus infection.
Bacterial tracheitis.
Epiglottitis.
Measles.
Peritonsillar abscess.

19. PREVENTION
Wash and dry your hands thoroughly after
caring for your child.
Wash toys between each use.
Encourage your child to cover his or her mouth
and nose when coughing and sneezing.
Keep your child home from school or day care
when he or she is ill or if outbreak occur.
Throw used tissues away.

20. SUMMARY
 Croup is an upper airway infection that block breathing and has a
distinctive barking cough.
 Also called laryngotracheobronchitis.
 Peak onset is children 2 years of age.
 Occur mainly late fall and early winter.
 History of presenting upper airway infection, Which develop
barking cough, hoarseness and stridor. Associated with low grade
fever.
 The diagnosis of croup is clinical.
 Physical examination helps identify the severity. Radiographic
finding is normal in many cases.
 It usually resulve within 3 days .
 Only 50% of pts with croup show the classical steeple sign on plain
radiography.

21. NEXT
PRESENTATION
MUMPS

22. MUMPS (PAROTITIS)
 DEFINITION: MUMPS is the Inflammation of the salivary
glands.
 Mainly the parotid glands are affected.
 There are three pairs of salivary glands.
 Two parotid glands, the largest, one in each cheek, over
the angle of the jaw , in front of the ear.
 Two sub mandibular glands at the back of the mouth.
 Two sub-lingual glands, under the floor of the mouth.

23. SALIVARY GLANDS .

24. VIRAL ETIOLOGY
 Caused by mumps virus called the paramyxovirus.
 It is an RNA virus.
 It spread from one child to an other through a direct
contact with a discharge from the nose and throat.
 Infected droplets in the air from a sneeze or close
conversation can be inhaled and may cause infection.

26. TRANSMISSION
By inhalation of respiratory droplets,
during sneezing and coughing.
The virus sheds in saliva.
Also, the virus can be transmitted by
direct contact with saliva.

27. CLINICAL FEATURES
 Mumps is a highly infectious child-hood disease.
 Mumps starts with moderate fever, malaise, pain on
chewing or swallowing, particularly acidic liquids.
 Followed by inflammation of the salivary glands,
particularly the parotid glands.
 The swelling appears in front of the ear.

28. PAROTITIS .

29. PROGNOSIS & LAB DIAGNOSIS
 In the absence of complications recovery is usual.
 Lab. Diagnosis, by detection of IgM antibody to
mumps virus.

30. TREATMENT
 There is no specific anti-viral drug therapy.
 Treatment is supportive by treating symptoms, using
antipyretics and analgesics.

31. CHILD CARE
The child must rest in bed until the fever goes away.
Isolate the child, to prevent spreading the disease to
other.
Use analgesics and anti-pyretic to ease symptoms.
Avoid food that require chewing.
Avoid sour foods that stimulate saliva production.
Drink plenty of water.
Use cold compress to ease the pain of swelling glands.

32. COMPLICATIONS
 Aseptic meningitis.
 Encephalitis.
 Orchitis, after puberty. Inflammation of one or both
testicles. Usually unilateral , rarely leads to sterility .
 Pancreatitis.
 Oophoritis.
 Thyroiditis.

33. DIFFERENTIAL DIAGNOSIS
 Bacterial (suppurative) parotitis
 Parotid duct stone
 Drug reactions
 Recurrent parotitis of childhood
 Parotid tumor

34. PREVENTION
A live attenuated vaccine is available (MMR).
It contains mumps, measles and rubella
attenuated virus strains.
Administered in one dose, intramuscularly or
subcutaneously.
The vaccine is protective.

35. SUMMARY
 Mumps is the inflammation of the salivary glands mainly
the parotid glands are affected.
 It is caused by mumps virus.
 Mumps is the most common salivary gland disease.
 Transmitted by inhalation of respiratory droplets during
sneezing and coughing.
 It also transmitted by direct contact with saliva.
 Mumps is highly infectious in child hood disease.
 In absent of complications recovery is usual.
 Prevented by vaccine and treated by supportive care.

36. THANK YOU ALL FOR
YOUR ATTENTION