A Family Doctor's Tale - CROUP

DOC I HAVE CROUP

Croup is a childhood viral disease which is seldom seen in the modern age.

The typical symptoms is the triad of inspiratory stridor( a whistling sound when the child breathes), fever and barking cough.

Treatment is usually symptomatic as it is a viral disease.

Prognosis is generally good in the absence of breathing complications.


Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.

It typically affects infants and children below 6 years old.

It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.

Croup is caused by:

Viral infections:


1.parainfluenza virus, primarily types 1 and 2

2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae

Genetic predisposition:


Some families are more prone than others to get the disease.
It is also more common in males than females.



Symptoms:

1.harsh barking cough

2.sneeze

3.inspiratory stridor (a high-pitched whistling sound during inspiration),

4.nausea and vomiting

5.fever.

6.Hoarseness -usually present

7.respiratory distress due to airway obstruction

8.lethargy

Signs:

1.Reduced breath sounds - air movement is reduced in the lungs

2.Prolonged inspiration on auscultation with laryngeal stridor

3.Chest retraction

4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Diagnosis of Croup is made based on:


1.Symptoms and signs of fever, laryngeal stridor and barking cough

2.blood tests (complete blood count, ESR and blood culture)

5.frontal X-ray of the Cervical spine
the presence of the the steeple sign confirms the diagnosis of croup.

Complications of Croup are:


1.Respiratory distress

2.Bacterial tracheitis

Treatment of Croup is by:


1.Rest, fluids and oxygen

2.Humidifiers and steam inhalations

3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation

4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed

5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways

6.Intubation and tracheostomy may be needed in severe cases.



Prognosis of croup  depends on the severity and type of infection.

Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.

Preventive measures taken for Croup are:


1.Vaccination against the influenza virus yearly may help.