Croup (Laryngotracheitis or Laryngotracheobronchitis).
Croup (Laryngotracheitis or Laryngotracheobronchitis):
Croup is a viral infection mostly caused by Parainfluenza virus (75%) , Influenza virus, Adenovirus, RSV, Measles virus and sometimes by Mycoplasma pneumoniae.
It produces Laryngotracheitis or Laryngotracheobronchitis.
Usually begins with URTI e.g. rhinorrhea, pharyngitis, mild cough, and low grade fever for 1-3 days before croup which characterized by barking cough, hoarseness of voice and inspiratory stridor, it may be worse at night and mainly occurs in winter months.
Hear barking cough in below video
Hear stridor in below video
Croup is mainly a clinical diagnosis, neck x-ray may show steeple sign (subglottic tracheal narrowing produces the shape of a church steeple within the trachea itself) but it's not specific
Mild cases (no stridor) can be managed at home by breathing cold air or using cool mist, while moderate and severe cases should be managed at hospital.
- The child should be calm as much as possible give O2 if dyspneic, hypoxic, cyanosed or has stridor.
- Nebulized adrenaline (racemic adrenaline if available) 0.5cc + 3cc NS, it can be used every 20 minutes.
- Dexamethasone (decadrone) 0.6mg/kg IM or oral
- Observation of the patient for few hours as symptoms may recur again when the effect of adrenaline goes away.