Croup
| Croup | |
| ICD-10 | J05.0 |
|---|---|
| ICD-9 | 464.4 |
| DiseasesDB | 13233 |
| MedlinePlus | 000959 |
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Croup Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Croup On the Web |
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American Roentgen Ray Society Images of Croup |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Signs and symptoms
Croup is characterized by a harsh 'barking' cough, inspiratory stridor (a high-pitched sound heard on inhalation), nausea/vomiting, and fever. Hoarseness is usually present. More severe cases will have respiratory distress.
The 'barking' cough (often described as a "seal like bark")[1] of croup is diagnostic. Stridor will be provoked or worsened by agitation or crying. If stridor is also heard when the child is calm, critical narrowing of the airway may be imminent.
In diagnosing croup, it is important for the physician to consider and exclude other causes of shortness of breath and stridor, such as foreign body aspiration and epiglottitis.
On a frontal X-ray of the C-spine, the steeple sign suggests the diagnosis of croup.
Causes
Croup is most often caused by parainfluenza virus, primarily types 1 and 3, but other viral and possibly bacterial infections can also cause it. It is most common in the fall and winter but can occur year-round, with a slight predilection for males.
The respiratory distress is caused by the inflammatory response to the infection, rather than by the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults', making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.
An entity known as spasmodic croup also occurs, distinct from the infectious variety, due to laryngeal spasms.
Treatment
The treatment of croup depends on the severity of symptoms.
One of the simplest ways to treat croup is to inhale hot steam. This was the sole treatment for croup throughout the nineteenth and most of the twentieth century. Hospitals today use a "blowby" apparatus for this purpose. Simpler remedies include taking the child outside in moist night air, or alternatively exposing the child to steam from a hot bath or a humidifier. These techniques may help in some cases, but there is little hard evidence to support their efficacy.
Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.
Moderate to severe croup may require nebulized adrenaline in addition to steroids. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).
Prognosis
Viral croup is a self-limited disease, but can very rarely result in death from complete airway obstruction. Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by (or confused with) an acute bacterial tracheitis, which is more dangerous.
References
- ↑ "Croup - Lucile Packard Children's Hospital". 2007-01-05.
External links
- MayoClinic
- Ask Dr. Sears
- Four kinds of croup http://www.healthscout.com/ency/68/135/main.html
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