; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. Ensure that the child has an adequate fluid intake. Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. Croup is one of the most common causes of upper airway obstruction in young children. [2] Fever and runny nose may also be present. [12] If oxygen is needed, "blow-by" administration (holding an oxygen source near the child's face) is recommended, as it causes less agitation than use of a mask. [5] The points given for each factor is listed in the adjacent table, and the final score ranges from 0 to 17. [5] In severe cases associated with influenza A or B, the antiviral neuraminidase inhibitors may be administered. [2][4] If the condition remains improved for 2–4 hours after treatment and no other complications arise, the child is typically discharged from the hospital. Chloride is driven against its concentration gradient using ATP. [5] Croup is typically diagnosed based on signs and symptoms after potentially more severe causes, such as epiglottitis or an airway foreign body, have been ruled out. It is primarily used for research purposes rather than in clinical practice. Susan M. Poutanen, in Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), 2018 Human Coronaviruses 229E, OC43, NL63, and HKU1. The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough, stridor, and a hoarse voice. [2] These symptoms may be mild, moderate, or severe. Severe Croup = frequent barking cough, prominent inspiratory stridor at rest, marked sternal wall retractions, child will appear distressed/agitated or lethargic or restless. Measles, also known as rubeola, is one of the most contagious infectious diseases, with at least a 90% secondary infection rate in susceptible domestic contacts. For the part of a quadruped, see, Respiratory condition that is usually triggered by an acute viral infection of the upper airway. You suspect a serious disorder caused by infection e.g. It presents with a harsh barking cough and other clinical features including including stridor, hoarseness of voice, and fever. Explaining that the symptoms usually resolve within 48 hours but may last for up to a week. Pathophysiology. Infection is transmitted via respiratory droplets, which can remain active and contagious, either airborne or on surfaces, for up to 2 hours. [13], Corticosteroids, such as dexamethasone and budesonide, have been shown to improve outcomes in children with all severities of croup. Croup is a viral upper respiratory tract infection which results in mucosal inflammation anywhere between the nose and trachea (2,5). The CTFR gene encodes the CFTR protein – a chloride channel that is present in numerous epithelial tissues. CF is a multisystem disease and below we will discuss the basic underlying pathophysiology and complications of the disease: Respiratory tract 2. Pathophysiology. Tachycardia may occur if more severe obstructive symptoms are present which can result in hypoxaemia. Thanks to the team at www.em3.org.uk we now have a 'Lightning Learning' resource for you to take away. [5] At one time, croup referred to a diphtherial disease, but with vaccination, diphtheria is now rare in the developed world. Croup is a common childhood illness causing symptoms which may involve a harsh barking cough, hoarse voice and (inspiratory) stridor. HCoVs 229E, OC43, NL63, and HKU1 are commonly associated with the common cold, which is typically characterized by rhinorrhea, nasal congestion, sore throat, sneezing, and cough that may be associated with fever. [2] In cases of possible secondary bacterial infection, the antibiotics vancomycin and cefotaxime are recommended. Original Author(s): Bethany Barraclough and Dr Hema Kannappa Last updated: 23rd April 2019 –          Red Flag symptoms for respiratory failure: drowsiness, lethargy (2), –          Chest sounds may be normal, but if there is a severe airflow limitation these sounds can be decreased, –          If in respiratory distress: tachypnoea, intercostal recession, –          Red Flag signs for respiratory failure: cyanosis, lethargic/decreased level of consciousness, laboured breathing, tachycardia (1,2). It is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor and respiratory distress caused by upper airway inflammation secondary to a viral infection. [5] Treatment, and response to treatment, are also similar. Epiglottitis (see table to differentiate from croup, 5), Laryngomalacia or another congenital cause of upper airway stenosis (eg, aortic arch abnormality causing external airway compression), Laryngeal mucosal lesions such as laryngeal web, papillomata and haemangioma. [2] Symptoms usually improve within two days, but may last for up to seven days. Epidemiological data of COVID-19. [2] The "barking" cough is often described as resembling the call of a sea lion. [5] The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. Croup, also known as laryngotracheobronchitis, is a type of respiratory infection that is usually caused by a virus. It can affect people of all ages, despite being considered primarily a childhood illness. If you do not agree to the foregoing terms and conditions, you should not enter this site. Croup, also known as acute laryngotracheitis or acute laryngotracheobronchitis (2), is a common viral childhood illness. The child has moderate/severe croup or impending respiratory failure. [4] Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally effective. The following organizations also provide reliable health information. [6][2][3], Croup can be caused by a number of viruses including parainfluenza and influenza virus. Respiratory difficulty is a common presenting complaint in the outpatient primary care setting. Inspiratory and expiratory stridor in a 13-month child with croup. The chest wall is compliant as the ribs are cartilaginous in nature and lie more horizontally than in an adult. Dehydration, as a consequence of not being able to maintain fluid intake (2), Rare: Bacterial superinfection resulting in pneumonia or bacterial tracheitis, Extremely rare: Pulmonary oedema, pneumothorax, Commonly affects children who are aged 6 months - 3 years, but can affect those who are as young as 3 months (1). "Duration of symptoms of respiratory tract infections in children: systematic review", "croup | Origin and meaning of croup by Online Etymology Dictionary", "Meaning of the Terms Diphtheria, Croup, and Faux Croup", "Something concerning the diagnosis and treatment of false croup", JAMA: The Journal of the American Medical Association, "Recognizing croup and stridor in children", Combined pulmonary fibrosis and emphysema, https://en.wikipedia.org/w/index.php?title=Croup&oldid=1014957348, Short description is different from Wikidata, Pages using Sister project links with default search, Wikipedia medicine articles ready to translate (full), Creative Commons Attribution-ShareAlike License, Laryngotracheitis, subglottic laryngitis, obstructive laryngitis, laryngotracheobronchitis, Usually 1–2 days but can last up to 7 days, A total score of ≥ 12 indicates impending, This page was last edited on 29 March 2021, at 23:01. [5], The viral infection that causes croup leads to swelling of the larynx, trachea, and large bronchi[4] due to infiltration of white blood cells (especially histiocytes, lymphocytes, plasma cells, and neutrophils). [3], Many cases of croup have been prevented by immunization for influenza and diphtheria. [3], Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Upper respiratory tract infection (URI) represents the most common acute illness evaluated in the outpatient setting. Previous history of severe airway obstruction, Have had a poor response to initial treatment. [4], Croup is typically diagnosed based on signs and symptoms. The most common organism is the parainfluenza virus; further organisms are given in the table below (2). As croup worsens, stridor may decrease considerably. Explaining that croup is a viral illness and antibiotics are not needed. [17][18], Diphtheritic croup has been known since the time of Homer's ancient Greece, and it was not until 1826 that viral croup was differentiated from croup due to diphtheria by Bretonneau. . [4][5], A frontal X-ray of the neck is not routinely performed,[4] but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign, because of the subglottic stenosis, which resembles a steeple in shape. [2][8] Hospitalization is required in one to five percent of cases. 2. [2] The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough, stridor, and a hoarse voice. Risk scoring (if relevant): See mild, moderate, severe classification above, Most children with mild croup can be managed at home but consider admission in the following cases: (1), Advice to parents for home-managed patients should include: (1), Immediate hospital admission should occur if: (1), Complications are rare and the majority of children do not need hospitalisation. [5] Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as stridor. [2], Other symptoms include fever, coryza (symptoms typical of the common cold), and indrawing of the chest wall–known as Hoover's sign. [15] The use of cough medicines, which usually contain dextromethorphan or guaifenesin, are also discouraged. Industry code of practice for the management of clinical and related wastes (6th ed.). Croup, also known as acute laryngotracheitis or acute laryngotracheobronchitis (2), is a common viral childhood illness. Inhalation of hot steam or humidified air is a traditional self-care treatment, but clinical studies have failed to show effectiveness[4][5] and currently it is rarely used. Biohazard Waste Industry [BWI]. [6] It can very rarely result in death from respiratory failure and/or cardiac arrest. [5], Viral croup is usually a self-limiting disease,[2] with half of cases resolving in a day and 80% of cases in two days. Acute severe asthma, also known as status asthmaticus, is an acute exacerbation of asthma that does not respond to standard treatments of bronchodilators (inhalers) and corticosteroids. [14], Moderate to severe croup may be improved temporarily with nebulized epinephrine. The noun describing the disease originated in southeastern Scotland and became widespread after Edinburgh physician Francis Home published the 1765 treatise An Inquiry into the Nature, Cause, and Cure of the Croup. [5] Laryngeal diphtheria is due to Corynebacterium diphtheriae while bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterial growth. Paracetamol or ibuprofen can be used to control pain and fever. Thanks to the team at www.em3.org.uk we now have a ‘Lightning Learning’ resource for you to take away. Jeanine P. Wiener-Kronish, David W. Shimabukuro, in Clinical Respiratory Medicine (Third Edition), 2008 I ndications and C ontraindications. New South Wales, Australia: Biohazard Waste Industry [BWI]. Pathophysiology In temperate areas, the peak incidence of infection occurs during late winter and spring. [5], The word croup comes from the Early Modern English verb croup, meaning "to cry hoarsely." [3] In rare cases, it may occur in children as young as 3 months and as old as 15 years. Humidified air/steam inhalation is not advised (2). [7] While effective when given by injection, or by inhalation, giving the medication by mouth is preferred. By visiting this site you agree to the foregoing terms and conditions. Coronaviruses are enveloped viruses with a positive-sense single-stranded RNA genome and a helical symmetry. [4] Further investigations—such as blood tests, X-rays, and cultures—are usually not needed. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site. References. [7] Significant relief is obtained as early as two hours after administration. [11], Croup is characterized by a "barking" cough, stridor, hoarseness, and difficult breathing which usually worsens at night. Diagnosis is normally a clinical decision. [12], Croup is usually deemed to be due to a viral infection. [5][10] This cause is now very rare in the Western world due to the success of the diphtheria vaccine. A large number of studies so far are reports based on experiences in China. Fever and runny nose may also be present. Make the changes yourself here! [4][5] It accounts for about 5% of hospital admissions in this population. (2010). [4] Children with oxygen saturation less than 92% should receive oxygen,[5] and those with severe croup may be hospitalized for observation. -          Red Flag symptoms for respiratory failure: drowsiness, lethargy (2), -          Chest sounds may be normal, but if there is a severe airflow limitation these sounds can be decreased, -          If in respiratory distress: tachypnoea, intercostal recession, -          Red Flag signs for respiratory failure: cyanosis, lethargic/decreased level of consciousness, laboured breathing, tachycardia (1,2). Ensure the child is kept as calm as possible as continuing crying increases oxygen demand & causes respiratory muscle fatigue (2). At the beginning of the outbreak, COVID-19 cases were mostly observed among elderly people [].As the outbreak continued, the number of cases among people aged 65 years and older increased further, but also some increase among children (< 18 years) was observed. The most common cocci implicated are Staphylococcus aureus and Streptococcus pneumoniae, while the most common bacteria are Haemophilus influenzae, and Moraxella catarrhalis. In this article, we will discuss the epidemiology, pathophysiology, clinical features and management of croup. [5], The most commonly used system for classifying the severity of croup is the Westley score. [5] Croup is usually treated with a single dose of steroids by mouth. This information is intended for medical education, and does not create any doctor-patient relationship, and should not be used as a substitute for professional diagnosis and treatment. To seek urgent medical advice if symptoms worsen e.g. Is our article missing some key information? Has decreased croup mortality 200% from before 1990 to now (from 0.5% to 0.03%) Dexamethasone [5], Viral croup or acute laryngotracheitis is most commonly caused by parainfluenza virus (a member of the paramyxovirus family), primarily types 1 and 2, in 75% of cases. [5] With treatment, less than 0.2% of children require endotracheal intubation. [5] It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions. The characteristic barking cough of croup is caused by the impaired movement of the vocal cords. [12], Other investigations (such as blood tests and viral culture) are discouraged, as they may cause unnecessary agitation and thus worsen the stress on the compromised airway. [4] The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis. Use the information in this article to help you with the answers. [2][7] In more severe cases inhaled epinephrine may also be used. Found an error? The mechanics of breathing in a child are influenced by their anatomy. [16] Since croup is usually a viral disease, antibiotics are not used unless secondary bacterial infection is suspected. [4] While epinephrine typically produces a reduction in croup severity within 10–30 minutes, the benefits last for only about 2 hours. [11][24], This article is about the respiratory condition. [3] Other viral causes include influenza A and B, measles, adenovirus and respiratory syncytial virus (RSV). http://cks.nice.org.uk/croup#!topicsummary, –          Typically a 1 to 4 day history of non-specific cough, rhinorrhoea and fever, progressing to a barking cough & hoarseness, -          Typically a 1 to 4 day history of non-specific cough, rhinorrhoea and fever, progressing to a barking cough & hoarseness, Commonly affects children who are aged 6 months – 3 years, but can affect those who are as young as 3 months (1), male:female incidence ratio of 1.43:1 in <6 month children & 1.73:1 in children aged 6 to 12 months. The most common indication for definitive airway management with endotracheal intubation is respiratory failure (i.e., failure of oxygenation and/or ventilation) and the need to deliver positive-pressure ventilation. Pathophysiology Structure. These symptoms may be mild, moderate, or severe. [3] Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn. [2] Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated. [21][22] False croup has also been known as pseudo croup or spasmodic croup. The genomic size of coronaviruses ranges from approximately 16 to 31 kilobases, extraordinarily large for an RNA virus. Croup cough in an 11-month child with croup. [4], Many cases of croup are preventable by immunization for influenza and diphtheria. Croup is a syndrome consisting of cough, stridor, hoarseness and varying degrees of difficulty breathing. The presenting symptoms vary according to the severity of disease: Mild Croup = occasional barking cough, no audible stridor at rest, no suprasternal or intercostal recession, child is happy and will drink, eat & play, Moderate Croup = frequent barking cough, audible stridor at rest, suprasternal and sternal wall retraction at rest, child is not distressed or agitated and will still show interest in its surroundings. [4] While viral cultures, obtained via nasopharyngeal aspiration, can be used to confirm the exact cause, these are usually restricted to research settings. [9] It occurs most often in autumn. [3] Often it starts or is worse at night and normally lasts one to two days. the development of intermittent stridor at rest or if the child starts to have a high fever and heart rate (this could indicate a different diagnosis such as bacterial tracheitis). The first two conditions involve a viral infection and are generally milder with respect to symptomatology; the last four are due to bacterial infection and are usually of greater severity. [9] Before vaccination, croup was frequently caused by diphtheria and was often fatal. Try again to score 100%. [11][15] Viral croup was then called "faux-croup" by the French and often called "false croup" in English,[19][20] as "croup" or "true croup" then most often referred to the disease caused by the diphtheria bacterium. Revisions: 14. Asthma is caused by multiple genes, some having protective effect, with each gene having its own tendency to be influenced by the environment although a genetic link leading to acute severe asthma is still unknown. It presents with a harsh barking cough and other clinical features including including stridor, hoarseness of voice, and fever.. Pathophysiology • Small caliber of ... • Can also cause croup and lower respiratory infections like bronchiolitis and pneumonia • Of every 100 infants and young children with RSV infection, 25 to 40 (25% to 40%) will show signs of pneumonia or bronchiolit is [3][4][9] It is slightly more common in males than females. [2][4] Others use the term more broadly, to include acute laryngotracheitis (laryngitis and tracheitis together), spasmodic croup, laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. [3], Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. [5], Children with croup should generally kept as calm as possible. [2][4], While other treatments for croup have been studied, none has sufficient evidence to support its use. [23] Croup due to diphtheria has become nearly unknown in affluent countries in modern times due to the advent of effective immunization. For any additional tests it is important to consider the distress that these could cause the child. [4] It most commonly occurs between 6 months and 5 years of age but may rarely be seen in children as old as fifteen. Basic science and pathophysiology of stridor. [4] A single dose is usually all that is required, and is generally considered to be quite safe. In this article, we will discuss the epidemiology, pathophysiology, clinical features and management of croup. [2][12] Drooling or a very sick appearance can indicate other medical conditions, such as epiglottitis or tracheitis. [3] Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema. It is usually caused by inflammation of the upper respiratory tract (predominantly the larynx and trachea but it may affect the bronchi) as a result of viral infection. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. In children that are intubated the mortality rates are less than 0.5% (2). Direct or indirect laryngoscopy is not usually performed unless the illness is atypical or another cause of airway obstruction is suspected. [5] Spasmodic croup is caused by the same group of viruses as acute laryngotracheitis, but lacks the usual signs of infection (such as fever, sore throat, and increased white blood cell count). [4] Steroids are given routinely, with epinephrine used in severe cases. Croup (see "Patient education: Croup in infants and children (Beyond the Basics)") ... Fever in infants and children: Pathophysiology and management. To call an ambulance if the child starts to show signs of respiratory failure. [13], 85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%). [9], Croup is a relatively common condition that affects about 15% of children at some point. See Dexamethasone in Croup (includes Nebulized Budesonide in Croup) Indicated in all croup cases, regardless of severity; Single dose lasts 60-72 hours and should cover the entire croup episode (typically 2-5 days) Most important single treatment in croup. C/C variant of the CD14 C-159T gene has been shown by genetic studies to have a lower prevalence of croup (2). Viruses causing acute infectious croup are spread through either direct inhalation from a cough and/or sneeze, or by contamination of hands from contact with fomites with subsequent touching the mucosa of the eyes, nose, and/or mouth. Editor-In-Chief: C. Michael Gibson, M.S., M.D. Chest X-Ray: To identify other possible causes of symptoms including inhaled foreign bodies. [2] There is tentative evidence that breathing heliox (a mixture of helium and oxygen) to decrease the work of breathing is useful in those with severe disease. URIs range from the common cold—typically a mild, self-limited, catarrhal syndrome of the nasopharynx—to life-threatening illnesses such as epiglottitis. [2] Rarely is it due to a bacterial infection. The steeple sign is suggestive of the diagnosis, but is absent in half of cases.

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