Croup is a severe inflammation and obstruction of the upper airway. This childhood disease affects boys more often than girls (typically between ages 3 months and 3 years).
Croup usually occurs in the winter as acute laryngotracheobronchitis (the most common form), laryngitis, or acute spasmodic laryngitis. It must be distinguished from epiglottiditis. Usually mild and self-limiting, acute laryngotracheobronchitis appears mostly in children ages 3 months to 3 years. Acute spasmodic laryngitis affects children between ages 1 and 3, particularly those with allergies and a family history of croup. Overall, up to 15% of patients have a family history of croup. Recovery is usually complete.
Croup usually results from a viral infection. Parainfluenza viruses cause about two-thirds of such infections; adenoviruses, respiratory syncytial virus, influenza viruses, measles viruses, and bacteria (pertussis and diphtheria) account for the rest.
Signs and Symptoms
The infection starts with a cold, cough, and low-grade temperature. Symptoms gradually develop over 2 days. The typical barking cough is usually present by day 3 and is more likely to be worse at night. The presence of stridor, hoarseness, difficulty swallowing, and respiratory distress is common but may or may not be severe.
In evaluating the patient with croup, diagnosis should rule out the possibility of masses, cysts, and foreign body obstruction - common causes of croupy cough in young children.
Throat cultures can identify infecting organisms and their sensitivity to antibiotics when bacterial infection is the cause. Throat cultures can also rule out diphtheria.
Blood cultures can distinguish between bacterial and viral infections, X-ray studies of the neck may show upper airway narrowing and edema in subglottic folds, and laryngoscopy may reveal inflammation and obstruction in epiglottal and laryngeal areas.
For most children with croup, home care with rest, cool humidification during sleep, and antipyretic drugs such as acetaminophen relieve signs and symptoms. However, respiratory distress that interferes with oral hydration usually requires hospitalization and parenteral fluid replacement to prevent dehydration. If the patient has croup from a bacterial infection, he needs antibiotic therapy. Oxygen therapy may also be required.
For moderately severe croup, aerosolized racemic epinephrine may temporarily reduce airway swelling. Intubation is performed only if other means of preventing respiratory failure are unsuccessful.
Several studies support the practice of prescribing corticosteroids for acute laryngotracheobronchitis.
Croup is a contagious disease. If possible, avoid contact with others who have colds or cough symptoms.
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