CROUP (LARYNGOTRACHEOBRONCHITIS)

PRESENTED BY: ARIF KHAN GROUP 4th YEAR 5TH

DEFINITION:Croup (or laryngotracheobronchitis) is a

respiratory condition that is usually triggered by an acute viral infection of the upper airway.

Croup is a common childhood disease characterised by

sudden onset of a distinctive barky cough that is usually accompanied by stridor, hoarse voice, and respiratory distress resulting from upper-airway obstruction.

INCIDENCE:Childrens are affected between 3 months to 5

years of age with a peak during second year of life.

The incidence is higher in males and can occur throughout the year with peaks in winter and late fall.

There may be an associated family history.

ETIOLOGY:Viral causes:Viral agents are more commonly implicated.The parainfluenza virus type 1, 2 and 3 are

the most common etiologies.Other viruses associated are influenza A and

B, adenovirus, respiratory synctial virus (RSV), and Measles.

Bacterial causes:Mycoplasma pneumoniae Corynebacterium diphtheriae  Staphylococcus aureus Streptococcus pneumoniae Hemophilus influenzae and Moraxella catarrhalis

CLINICAL FEATURES:Croup is characterized by a "barking" cough,

stridor,  hoarseness, and difficult breathing  which usually worsens at night.The "barking" cough is often described as resembling the call of a seal or sea lion.The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways.

Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing.

Diagnostic evaluation:A frontal X-ray of the

neck- it may show a characteristic narrowing of the trachea, called the steeple sign, because of the subglottic stenosis, which is similar to a steeple in shape. (inverted v shape)

LTB and LTBP (IncludingBacterial Tracheitis)

Inflammation of the larynx,trachea, and bronchi or lung; usually similar in onset to laryngotracheitis, but with more severe illness.

3 mo to 3 yr. Usually coryza Hoarseness and barking cough;

no dysphagia; inspiratory stridor, usually severe; typically toxic presentation

Fever, generally 37.8 to 40.5°C; usually minimal pharyngitis; normal epiglottis

Subglottic narrowing on posterior–

anterior view, irregular soft-tissue densities in trachea on lateral view,bilateral pneumonia

Infection involving the larynx and other areas of the airway due to Corynebacterium diphtheriae, resulting in progressive airway obstruction.

All ages . Usually pharyngitis Hoarseness and barking

cough; usually dysphagia;minimal-to-severe inspiratory stridor; usually nontoxic presentation

Fever, generally 37.8 to 38.5°C; membranous pharyngitis; epiglottis usually normal but may contain membrane

Not useful

Laryngeal Diphtheria

Definition

Typical age at occurrence:

Prodrome:

Symptoms onpresentation

Signs on presentation

Radiographicfindings

CONTD

Usually elevated or abnormally low, with >70% neutrophils and increased percentageof band forms.

Most commonly caused by parainfluenza virus 1(responsible for frequent fall outbreaks); many other viruses also implicated ,including other parainfluenza viruses and influenza viruses (influenza virus A and parainfluenza virus 3 often cause severe cases), respiratory syncytial virus, measles virus, adenoviruses, and rhinoviruses.

Usually elevated, with increased percentage of band forms.

C. diphtheriae (identified on smear and culture of membrane)

LTB and LTBP

White-cell count

Laryngeal Diphtheria

Microbiologicfindings

CONTD..Nasopharyngeal aspirate- Viral cultureWBC CountClinical diagnosis doneOther investigations are excluded to prevent

unnecessary agitation and thus improve the stress.

The Westley Score: Classification of croup severity

Feature

Number of points assigned for this feature

0 1 2 3 4 5

Chest wallretraction

None Mild Moderate Severe

Stridor None Withagitation At rest

Cyanosis None Withagitation At rest

Level ofconsciousness

Normal Disoriented

Air entry Normal Decreased

Markedly decreased

Scoring system:A total score of ≤ 2 indicates mild croup. A total score of 3–5 is classified

as moderate croup. A total score of 6–11 is severe croup. A total score of ≥ 12 indicates

impending respiratory failure.( The score ranges from 0-17)

TREATMENT:Supportive care including intravenous fluids

to maintain hydration and oxygen inhalation to relieve hypoxia has to be given.

A single dose of dexamethasone 0.6 mg/kg may decrease the severity and duration of illness.

Inhalation of epinephrine may decrease the symptoms of stridor and respiratory distress immediately.

Antibiotics are not usually indicated.A helium–oxygen mixture (heliox) has been shown in a small study to improve croup-severityscores in hospitalized children with croup.

Treatment in cases of bacterial requires close observation, broad-spectrum antibiotics, and, occasionally, endotracheal intubation.

COMPLICATIONS:Complications in croup are rare. In most

series, less than 5% of children who were diagnosed with croup required hospitalization and less than 2% of those who were hospitalized were intubated. Death occurred in approximately 0.5% of intubated patients.

Extension of infectious process to other regions of the respiratory tract, e.g. middle ear or pulmonary parenchyma.

Bacterial tracheitis

PREVENTION:Many cases of croup have been prevented

by immunization for influenza and diphtheria.

PROGNOSIS:Viral croup is usually a self-limited disease,

but can very rarely result in death from respiratory failure .

Symptoms usually improve within two days, but may last for up to seven days.

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