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Croup

Background knowledge ๐Ÿง 

Definition

  • Croup is a viral infection that causes inflammation of the larynx, trachea, and bronchi
  • Characterized by a distinctive barking cough, hoarseness, and stridor
  • Primarily affects young children, especially those aged 6 months to 3 years

Epidemiology

  • Common in children aged 6 months to 3 years
  • More frequent in boys than girls
  • Peaks in autumn and early winter
  • Accounts for 15% of respiratory tract infections in children
  • Recurrent in some children

Aetiology and Pathophysiology

  • Most commonly caused by parainfluenza viruses
  • Other viruses include respiratory syncytial virus (RSV), adenovirus, and influenza
  • Viral infection leads to inflammation and swelling of the subglottic area
  • Narrowing of the airway causes the characteristic stridor and barking cough
  • Symptoms often worse at night

Types

  • Viral croup: Most common, caused by viral infection
  • Spasmodic croup: Similar symptoms but not caused by infection, often recurrent and may have an allergic component
  • Bacterial tracheitis: Severe bacterial infection, rare, and requires immediate medical attention

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Barking cough
  • Hoarseness
  • Stridor (high-pitched, wheezing sound)
  • Difficulty breathing
  • Fever
  • Symptoms often worse at night
  • Irritability and restlessness

Signs

  • Inspiratory stridor
  • Suprasternal and intercostal retractions
  • Tachypnea
  • Increased work of breathing
  • Cyanosis in severe cases
  • Agitation
  • Low oxygen saturation in severe cases

Investigations ๐Ÿงช

Tests

  • Clinical diagnosis based on history and examination
  • Pulse oximetry to monitor oxygen saturation
  • Neck X-ray in atypical cases to rule out other conditions
  • Viral swabs may be done during outbreaks or for research purposes
  • Blood tests not routinely required

Management ๐Ÿฅผ

Management

  • Mild croup: Managed at home with oral dexamethasone and supportive care
  • Moderate to severe croup: Hospitalization, nebulized adrenaline, and corticosteroids
  • Humidified air may help in mild cases
  • Avoidance of distressing the child as this can worsen symptoms
  • Ensure hydration and antipyretics for fever

Complications

  • Respiratory failure
  • Secondary bacterial infection (e.g., bacterial tracheitis)
  • Pneumonia
  • Pulmonary edema in severe cases
  • Rarely, death if untreated or in severe cases

Prognosis

  • Generally good prognosis with appropriate treatment
  • Symptoms typically resolve within a week
  • Recurrent episodes possible in some children
  • Severe cases require prompt medical attention
  • Follow-up to ensure complete resolution of symptoms

Key points

  • Croup is a common viral illness in young children
  • Characterized by a barking cough and stridor
  • Most cases are mild and can be managed at home
  • Moderate to severe cases require hospital management and possibly nebulized treatment
  • Complications are rare but can be severe

References

  • NICE Clinical Knowledge Summary on Croup (https://cks.nice.org.uk/topics/croup/)
  • BNF – British National Formulary (https://bnf.nice.org.uk/)
  • NHS Inform – Croup (https://www.nhsinform.scot/illnesses-and-conditions/children/croup)
  • BMJ Best Practice – Croup (https://bestpractice.bmj.com/topics/en-gb/3000111)

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