Croup

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Laryngotracheobronchitis
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This article is about the respiratory condition. For the part of a quadruped, see rump (animal). For the crop of a bird, see crop (anatomy). For the type of casino employee, see croupier.

Croup
Other namesLaryngotracheitis, subglottic laryngitis, obstructive laryngitis, laryngotracheobronchitis
epinephrine[4][5]
Frequency15% of children at some point[4][5]
DeathsRare[2]

Croup, also known as laryngotracheobronchitis, is a type of

runny nose may also be present.[2] These symptoms may be mild, moderate, or severe.[3] Often it starts or is worse at night and normally lasts one to two days.[6][2][3]

Croup can be caused by a number of viruses including

X-rays and cultures, are usually not needed.[4]

Many cases of croup are preventable by

epinephrine may also be used.[2][8] Hospitalization is required in one to five percent of cases.[9]

Croup is a relatively common condition that affects about 15% of children at some point.[4] It most commonly occurs between six months and five years of age but may rarely be seen in children as old as fifteen.[3][4][9] It is slightly more common in males than females.[9] It occurs most often in autumn.[9] Before vaccination, croup was frequently caused by diphtheria and was often fatal.[5][10] This cause is now very rare in the Western world due to the success of the diphtheria vaccine.[11]

Signs and symptoms

Stridor
Inspiratory and expiratory stridor in a 13-month child with croup.
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Croupy cough
Croup cough in an 11-month child with croup.
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Croup is characterized by a "barking"

hoarseness, and difficult breathing which usually worsens at night.[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. As croup worsens, stridor may decrease considerably.[2]

Other symptoms include

chest wall–known as Hoover's sign.[2][12] Drooling or a very sick appearance can indicate other medical conditions, such as epiglottitis or tracheitis.[12]

Causes

Croup is usually deemed to be due to a viral infection.[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. 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.[5]

Viral

Viral croup or acute laryngotracheitis is most commonly caused by

white blood cell count).[5] Treatment, and response to treatment, are also similar.[3]

Bacteria and cocci

Croup caused by a bacterial infection is rare.[13] Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis.[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. The most common cocci implicated are Staphylococcus aureus and Streptococcus pneumoniae, while the most common bacteria are Haemophilus influenzae, and Moraxella catarrhalis.[5]

Pathophysiology

The viral infection that causes croup leads to swelling of the

neutrophils).[5] Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as stridor.[4]

Diagnosis

Westley score: Classification of croup severity[3][14]
Feature Number of points assigned for this feature
0 1 2 3 4 5
Chest wall
retraction 		None Mild Moderate Severe
Stridor None With
agitation 		At rest
Cyanosis None With
agitation 		At rest
Level of
consciousness
 Normal Disoriented
Air entry Normal Decreased Markedly decreased

Croup is typically diagnosed based on signs and symptoms.

bacterial tracheitis.[4][5]

A frontal

steeple in shape. The steeple sign is suggestive of the diagnosis, but is absent in half of cases.[12]

Other investigations (such as

nasopharyngeal aspiration, can be used to confirm the exact cause, these are usually restricted to research settings.[2] Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated.[5]

Severity

The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice.[5] It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.[5] The points given for each factor is listed in the adjacent table, and the final score ranges from 0 to 17.[14]

  • A total score of ≤ 2 indicates mild croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest.[3]
  • A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs.[3]
  • A total score of 6–11 is severe croup. It also presents with obvious stridor, but also features marked
    chest wall indrawing.[3]
  • A total score of ≥ 12 indicates impending respiratory failure. The barking cough and stridor may no longer be prominent at this stage.[3]

85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%).[3]

Prevention

Croup is contagious during the first few days of the infection.[13] Basic hygiene including hand washing can prevent transmission.[13] There are no vaccines that have been developed to prevent croup,[13] however, many cases of croup have been prevented by immunization for influenza and diphtheria.[5] At one time, croup referred to a diphtherial disease, but with vaccination, diphtheria is now rare in the developed world.[5]

Treatment

Most children with croup have mild symptoms and supportive care at home is effective.

cough medicines, which usually contain dextromethorphan or guaifenesin, are also discouraged.[2]

Supportive care

Supportive care for children with croup includes resting and keeping the child hydrated.

inspiratory stridor, working hard to breathe, blue (or blue-ish) coloured lips, or decrease in the level of alertness), immediate medical evaluation by a doctor is required.[13]

Steroids

by injection, or by inhalation, giving the medication by mouth is preferred.[4] A single dose is usually all that is required, and is generally considered to be quite safe.[4] Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally effective.[16]

Epinephrine

Moderate to severe croup (for example, in the case of severe stridor) may be improved temporarily with

epinephrine.[4] While epinephrine typically produces a reduction in croup severity within 10–30 minutes, the benefits are short-lived and last for only about 2 hours.[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.[2][4] Epinephrine treatment is associated with potential adverse effects (usually related to the dose of epinephrine) including tachycardia, arrhythmias, and hypertension.[15]

Oxygen

More severe cases of croup may require treatment with oxygen. 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]

Other

While other treatments for croup have been studied, none has sufficient evidence to support its use. There is tentative evidence that breathing

neuraminidase inhibitors may be administered.[5]

Prognosis

Viral croup is usually a

bacterial tracheitis, pneumonia, and pulmonary edema.[3]

Epidemiology

Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years.[4][5] It accounts for about 5% of hospital admissions in this population.[3] In rare cases, it may occur in children as young as 3 months and as old as 15 years.[3] Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn.[5]

History

The word croup comes from the Early Modern English verb croup, meaning "to cry hoarsely." 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.[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.[11][19] Viral croup was then called "faux-croup" by the French and often called "false croup" in English,[20][21] as "croup" or "true croup" then most often referred to the disease caused by the diphtheria bacterium.[22][23] False croup has also been known as pseudo croup or spasmodic croup.[24] Croup due to diphtheria has become nearly unknown in affluent countries in modern times due to the advent of effective immunization.[11][25]

One famous fatality of croup was

Josephine de Beauharnais.[26]

References

  1. ^ "Croup". Macmillan. Retrieved 1 April 2020.
  2. ^
    PMID 20485713
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  3. ^
    PMID 19445760
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  4. ^
    PMID 19135584
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  5. ^
    PMID 18216359
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  6. ^
    PMID 24335668
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    PMID 36626194
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  8. PMID 24114291
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  9. ^
    PMID 23939212
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  10. ISBN 978-0-87842-505-1
    .
  11. ^
    ISBN 978-0-7216-9329-3
    .
  12. ^ a b c d "Diagnosis and Management of Croup" (PDF). BC Children's Hospital Division of Pediatric Emergency Medicine Clinical Practice Guidelines. Archived from the original (PDF) on 2020-06-23. Retrieved 2020-03-16.
  13. ^
    S2CID 242149254
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  14. ^
    PMID 10629679
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  15. ^
    PMID 34397099
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  16. S2CID 6655787
    .
  17. doi:10.1017/CHOL9780521332866.092
    .
  18. ^ "croup | Origin and meaning of croup by Online Etymology Dictionary". www.etymonline.com. Archived from the original on 2011-05-10. Retrieved 27 February 2020.
  19. PMID 18159359
    .
  20. PMID 20747853
    .
  21. doi:10.1001/jama.1895.02430400011001d. Archived
    from the original on 4 July 2014. Retrieved 16 April 2014.
  22. PMID 20747854
    .
  23. ^ Beard GM (1875). Our Home Physician: A New and Popular Guide to the Art of Preserving Health and Treating Disease. New York: E. B. Treat. pp. 560–564. Retrieved 15 April 2014.
  24. ISBN 978-0-323-26373-3. Archived
    from the original on 2017-09-08.
  25. ^ Vanderpool P (December 2012). "Recognizing croup and stridor in children". American Nurse Today. 7 (12). Archived from the original on 16 April 2014. Retrieved 15 April 2014.
  26. ^ Bruce E (1995). Napoleon and Josephine. London: Weidenfeld & Nicolson.

External links

  • "Croup". MedlinePlus. U.S. National Library of Medicine.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Croup&oldid=1212413882#Causes"