Virus transmission (mainly parainfluenza and RSV) can occur due to direct inoculation of secretion which carry the virus through the hands or by large inhalation particles entering through the eyes or nose. Virus infection in laryngotracheitis, laryngotracheobronchitis and laryngotracheobronchopneumonia usually starts from the nasopharynx or oropharynx which get down to the larynx and trachea after an incubation period of 2-8 days. Diffuse inflammation that causes erythema and edema of the mucosa wall of the respiratory tract. Larynx is the narrowest part of upper respiratory tract, which makes it very suspectible to the occurrence of obstruction. The same mucosa edema in adults and children will lead to different refinement. Mucosa edema with 1 mm thickness will cause airway narrowing by 44% in children and 75% in infants.
Mucosa edema of glottis area will cause a disruption of vocal cord mobility. edema on subglottis area can also cause symptoms of shortness of breath. Airway narrowing due to inflammation causes air turbulence that causes stridor.
In Laryngotracheitis acute edematous area, there are histologically containing cellular infiltrates in the lamina propria, submucosal and advensisia. These infiltrates contain histiocytes, lymphocytes, plasma cells, and neutrophils.
Atopic Dermatitis (AD) is an inflammatory skin reaction disease based on hereditary factors and enviromental factors, are chronic reccurent with symptoms are erythema, papules, vesicles, leprosy, squama and servere pruritus. If reccurent, Atopic dermatitis is usually accompanied by infections or allergies, psychological factors, or caused by chemicals or irritants. This disease is called atopic dermatitis, because as most sufferers by giving skin reactions based on Ig E and has tendency to suffer from asthma, rhinitis or both at a later date, known as the allergic march. Nevertheless, the term atopic dermatitis doesn’t always mean that the disease waqs based on the interaction of antigen with antybody. Another name for atopic dermatitis is atopic eczema, prurgo Besnier, and neurodermatitis.
Poorly defined erythematous plaques, with or without scale Excoriations occur as a consequence of scratching and rubbing. Secondarily infected sites: pustules (usually follicular), crusts.
Chronic Lichenification a thickening of the skin with accentuation of skin markings, which results from repeated rubbing or scratching: diffusely lichenified areas; nodular lichenification (may be confused with prurigo nodularis)
Chronic Recurrent Papular and lichenified plaques, excoriations, pustules, erosions, dry and wet crusts, and cracks (fissures)
DISTRIBUTION Often generalized, with predilection for the flexures, front and sides of the neck, eyelids, forehead, face, wrists, and dorsa of feet and hands
Epiglottitis is an infection which attacks epiglotits and supraglotis structure, makes acute airway obstruction and cause death if not treated. Acute epiglottis an emergency so that the diagnosis should be established as quickly as possible, but must be done quickly and precisely in order to reduce mortality. The situation that is potentially deadly and dramatic this usually occurs in children aged 2-7 years, peak incidence occurs at age 3.5 years.
Epiglotitis almost always caused by Hemophilus influenza type B. Other causes are S. aureus, S. pneumonia, C.albicans, viruses and trauma.
c. Clinical manifestations
Epiglotitis marked by a sudden high fever and severe sore throat, shortness of breath, followed by symptoms of progressive airway obstruction quickly, can deteriorate into total obstruction of breathing and death.In younger children initially good general condition, often appear either before sleep but then wake up at night with high fever, afoni, protruding tongue, accompanied by severe breathing (respiratory disstres) moderate or severe stridor with inspiration.
Older children, initially complained of sore throat and dysphagia, the patient prefers a sitting position, body bent forward with his mouth open and neck extension. Respiratory crisis can occur within minutes or start 3-4 days after the occurrence of rhinitis. Inconvenience or substernal chest pain under the front there and could often compounded by coughing. When the condition getting worse, patients may be disturbed by the sound of whistling during respiration (may ronkhi), chest pain, and sometimes by shortness of breath.
The diagnosis is based on the discovery of a large epiglottis, swollen and red cherries, with checks or direct laryngoscopy. On radiological examination showed picture thumb sign.
Provision of oxygen
Provision of weight adjusted intravenous fluids and hydration status
Provision of Salin Sulfate inhalation
Intubation or tracheostomy
Antibiotics given intravenously in the form of third-generation cephalosporins (cefotaxim or ceftriaxone), sefotaxim (50-100 mg / kg / day in three divided doses) for 7-10 days and free child fever two days, while ceftriaxone (50-100 mg / kg / day) can be given a single dose for 5 days.
Otitis media is an acute inflammation of the middle ear which associated with effusion and a buildup of fluid in the middle ear. Usually, interference occurs the middle ear aeration is caused by a disturbed function of eustachius duct.
In most cases, Acute otitis media caused by a virus, but it is difficult to distinguish between viral or bacterial etiology based on clinical presentation and examination using otoskop only. Acute otitis media is usually exacerbated by upper respiratory infections caused by viruses that cause edema in the eustachius fallopian. This resulted in an accumulation of fluid and mucous which then is infected by bacteria. The most common pathogens infecting the children are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. Bacteria are involved in different chronic infection with acute otitis media, where P. aeruginosa, Proteus species, Staphylococcus aureus, and the combined anaerobic become real.
c. Risk factors
Age under 2 years
White, American Indian
The first attack usually under 6 months
S. Infection Pneumonia.
d. Clinical manifestations
Classic symptoms include pain, fever, malaise, and sometimes in addition to head pain, ear pain, especially in children can occur anorexia and sometimes nausea and vomiting. Fever may be high but may also not found in 30% of cases. All or part of the tympanic membrane is typically become red and prominent, and blood vessels in the tympanic membrane and stalk malleolus dilates and becomes prominent. It is best diagnosed using pneumatic otoskop. If otoskop not available, should be suspected of an acute otitis media if there is discharge coming out of the ear for less than two weeks, or there is a sudden ear pain, persisten.
Examination of the tympanic membrane showed a reduced movement, convex, reddish and turbid, it can also be found that purulent secretions.
Oral amoxicillin 40 mg / kg / day, three times a day for 10 days
The second option can be given a combination of erythromycin 50 mg / kg / day with sulphonamides 100 mg / kg / day or sulfiksoksazol 150 mg / kg / day four times a day.
Supportive therapy: analgesics, antipyretics, decongestants.
Patients with severe ear pain conducted miringotomi