From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Abstract Croup syndromes are common in children, most frequently being infectious in origin. Children are best cared for at home. Hospitalization is typically indicated for increasing or persistent respiratory distress, tachycardia, fatigue, cyanosis or hypoxemia, or dehydration. Children are variably febrile and with progression of disease, exhaustion, agitation, cyanosis and air hunger may develop. Likewise, taking a breath often produce… The child’s condition may seem to have improved in the morning but worsens again at night. Children present with a slow progression of respiratory and expiratory stridor and a croupy, “barking seal” cough. Croup is a condition caused by a viral infection. Croup and cough. Consequently leading to localized inflammatory response including Inflammation of the subglottic area Mucosal oedema Increased mucous production Swelling of the involved airway particularly involving the lateral walls of the trachea just below the … The usual presenting symptom in neonates is a vesicular eruption that appears between the 1st and 3rd week of life. Seriously ill patients, in whom epiglottitis is a concern, should be examined in the operating room by appropriate specialists able to establish an airway (see Epiglottitis : Treatment). endstream endobj 33 0 obj <>stream Croup is the most common pediatric illness that causes acute stridor, accounting for approximately 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. ETIOLOGY AND PATHOPHYSIOLOGY Croup is caused by viral infections of the respiratory tract and most commonly by parainfluenza types 1 and 3 viruses. Do not hesitate to seek medical help if this is the case. Bacterial strains can cause croup in adults, but such cases are rare. If the diagnosis is unclear, patients should have AP and lateral x-rays of the neck and chest; subepiglottic narrowing (steeple sign) seen on AP neck x-ray supports the diagnosis. An x-ray scan of the neck may help distinguish croup from other causes, but this is also rarely needed unless the initial symptoms and signs or the course of illness are different than expected. CO2 retention (PaCO2 > 45 mm Hg) generally indicates fatigue and the need for endotracheal intubation, as does inability to maintain oxygenation. Symptoms are usually worse at night. Give cool, humidified air or oxygen, and sometimes corticosteroids and nebulized racemic epinephrine. High-dose dexamethasone 0.6 mg/kg IM or orally once (maximum dose 10 mg) may benefit children early in the first 24 hours of the disease. A mildly ill child may be cared for at home with hydration and antipyretics. Croup caused by influenza may be particularly severe and may occur in a broader age range of children. Please confirm that you are a health care professional. Diagnosis is usually clinical, but an anteroposterior x-ray of the neck and chest showing classic subepiglottic narrowing (steeple sign) supports the diagnosis. Most cases are mild. There are several ways in which this disease is transmitted to the neonate. What causes croup? Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Croup is a viral condition that causes swelling around the vocal cords. Croup is primarily a disease of infants and toddlers, with an age peak incidence of … These infections cause generalized airway inflammation and edema of the upper airway mucosa. What is Croup? The usual cause of croup is a viral infection. Croup is caused by viral infections of the respiratory tract and most commonly by parainfluenza types 1 and 3 viruses. A barking, often spasmodic cough and sometimes inspiratory stridor (caused by subglottic edema) are the most … Most children who present with acute onset of barky cough, stridor, and chest-wall indrawing have croup. Add this result to my export selection Croup: What are the differential diagnoses of croup? This swelling makes the airway narrower, so it is harder to breathe. It has been reported to occur in infants younger than 6 months, in adolescents, and, more rarely, in adults. A foreign body may cause respiratory distress and a typical croupy cough, but fever and a preceding upper respiratory infection are absent. Typically, it affects those between 6 months and 3 years of age, peaking in the second year of life. Croup is usually preceded by upper respiratory infection symptoms. The parainfluenza virus triggers a croup cough in adults. The condition is contagious, especially in the first few days or until your childs fever is gone. Croup … Croup is the most common pediatric illness that causes acute stridor, accounting for approximately 15% of annual clinic and emergency department visits for pediatric respiratory tract infections. It is characterized by the sudden onset of a seal-like barking cough usually accompanied by stridor (predominantly inspiratory), hoarse voice, and respiratory distress due to upper-airway obstruction. Epiglottitis, retropharyngeal abscess, and bacterial tracheitis cause a more toxic appearance than croup and are not associated with a brassy, barking cough. The viruses that most commonly cause croup do not usually predispose to secondary bacterial infection, and antibiotics are rarely indicated. Croup is more common in the fall and early winter. Suspect croup in a child with a sudden-onset, seal-like barking cough, often accompanied by stridor and chest wall (intercostal) or sternal indrawing. v�qu������b���,t��YM��$�o)���7O I< �NX2a�O�a���M]A�r�. The obvious respiratory distress and harsh inspiratory stridor are the most dramatic physical findings. Neonatal herpes simplex virus (HSV) infection has a high morbidity and mortality rate. A child with severe croup will need prompt treatment in hospital. Spread is usually through the air or by contact with infected secretions. Croup is a common, primarily pediatric viral respiratory tract illness. It’s characterized by breathing difficulties and a bad cough that sounds like a barking seal. "�A�=� �c� @���� lg@z���� �֑���a ��������x�@� >4 0 endstream endobj startxref 0 %%EOF 54 0 obj <>stream Similar inspiratory stridor can result from epiglottitis, bacterial tracheitis, airway foreign body, diphtheria, and retropharyngeal abscess.Epiglottitis, retropharyngeal abscess, and bacterial tracheitis have a more rapid onset and cause a more toxic appearance, odynophagia, and fewer upper respiratory tract symptoms. Croup (laryngotracheobronchitis) is a common childhood disease that is usually caused by a virus. This drug is recommended mainly for patients with moderate to severe croup. Epiglottitis, retropharyngeal abscess, and bacterial tracheitis have a more rapid onset and cause a more toxic appearance, odynophagia, and fewer upper respiratory tract symptoms. Keeping the child comfortable is important because fatigue and crying can aggravate the condition. Allergy or airway reactivity may play a role in spasmodic croup, but the clinical manifestations cannot be differentiated from those of viral croup. Croup Fact Sheet 1. Obstruction caused by swelling and inflammatory exudates develops and becomes pronounced in the subglottic region. Similar inspiratory stridor can result from epiglottitis, bacterial tracheitis, airway foreign body, diphtheria, and retropharyngeal abscess. However, the effects are transient; the course of the illness, the underlying viral infection, and the PaO2 are not altered by its use. Check if your child has croup. Last full review/revision Jun 2020| Content last modified Jun 2020, Croup is acute inflammation of the upper and lower respiratory tracts most commonly caused by, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Delivery through an infected maternal genital tract, Hospital spread from one neonate to another, Blood transfusion around the time of birth, X-Ray of a Child With Croup (Sagittal View), X-Ray of a Child With Croup (Coronal View), Musculoskeletal and Connective Tissue Disorders. Diagnosis of croup is usually obvious by the barking nature of the cough. Croup is a frequent cause of acute respiratory distress in young children. Diagnosis of croup is usually obvious by the barking nature of the cough. The virus leads to swelling of the voice box (larynx) and windpipe (trachea). Children present with a slow progression of respiratory and expiratory stridor and a croupy, “barking seal” cough. The child may awaken at night with respiratory distress, tachypnea, and retractions. Croup is primarily a disease of infants and toddlers, with an age peak incidence of age 6 months to 36 months (3 years). 2. Leonard R. Krilov, MD† 1. • Although viral croup is the most common form of airway obstruction in children 6 months to 6 years of age, there is debate regarding medical care for the hospitalized patient. Children are variably febrile and with progression of disease, exhaustion, agitation, cyanosis and air hunger may develop. As its alternative names, acute laryngotracheitis and acute laryngotracheobronchitis, indicate, croup generally affects the larynx and trachea, although this illness may also extend to the bronchi. What Causes Croup in Adults? The diagnosis is primarily based on clinical findings; imaging studies may be useful in selected cases. 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