CROUP

By Dr.Sally Zeinatie


DEFINITION:

The term croup does not refer to a single illness, but rather a group of conditions involving inflammation of the upper airway that leads to a cough that sounds like a bark, particularly when a child is crying.


It is a respiratory disease which afflicts infants and young children, typically aged between 3 months and 3 years.

CAUSES:

Most croup is caused by viruses, but similar symptoms may occasionally be caused by bacteria or an allergic reaction.


The viruses most commonly involved are parainfluenza virus (accounting for most cases), adenovirus, respiratory syncytial virus, influenza, and measles.

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") 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 stridorsuch as foreign body aspiration and epiglottitis.


On a frontal X-ray of the C-spine, the steeple sign suggests the diagnosis of croup.


Treatment:

The treatment of croup depends on the severity of symptoms.
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 an acute bacterial tracheitis which is more dangerous.

Complications:

Respiratory distress
Respiratory arrest
Epiglottitis
Bacterial tracheitis
Atelectasis
Dehydration

Prevention:

Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to reduce the chance of spreading the viruses that cause croup.