Medical symptom checker- Barking cough - Croup symptoms
Acute laryngotracheobronchitis or croup.
It is a common condition caused by inflammation of the respiratory tract that progressively spreads from the larynx to the trachea and bronchi secondary to viral infection.
The most common cause is parainfluenza virus.However other viruses may produce the same effect such as rhinoviruses, RSV and influenza viruses.
It is associated with other factors that lead to acute stridor such as marked tonsillar swelling in case of infectious mononucleosis, diptheria where immunization status need to be checked,the ingestion or swallowing of foreign bodies which can be characterized from clear history an acute onset, acute epiglottitis which is presented with no cough, child is toxic and drooling symptoms that develops over shorter period of times or hours and anaphylaxis reaction with the present of wheals, urticaria and known allergy and tracheitis that is characterized with toxic child, no drooling but present with croupy cough.
It is commonly present in winter months with repeated episodes in children mostly from 6 months to 5 years old.
The child usually suffer from coryza ( flu/feverlike symptoms) that lasted for 1- 3 days. The child also suffers from barking croupy cough and hoarseness in voice which is the symptoms of laryngitis and suffer from stridor ( seal -like yelp ) 1-2 days after the onset of cough which is the symptoms of tracheitis, The final component of croup includes bronchitis where there is an increase in the respiratory effort as the infection spreads down the bronchial tree.
Examine the child in a calm environment with minimal disturbance. Classification of severity of croup to determine management:
After taking the history from the patient the next step is to examine the child in a minimal disturbance with calm environment. The purpose of the examination is to classify the severity of the croup to determine the form of treatment and management.
In case of mild croup - The child has no case of stridor with normal heart rates (HR), normal respiratory rates (RR), normal GSC ( Glasgow Coma Scale) and normal oxygen saturation ( O2) and no chest recession.
In the case of moderate croup - The child present with mild chest recession, normal respiratory rates, ( RR ) the present of stridor at rest which is audible with stethoscope and air entry (AE) which decrease but easily audible. The GCS ( Glasgow coma scale ) is normal while the oxygen saturation is more than 93% and increase in the heart rate ( HR).
In the case of severe croup- the child present with severe stridor at rest which is audible without stethoscope. The child also present with laboured breathing and tachypnoea with chest recession. The oxygen saturation is less than 93% and there is an alteration of GCS ( Glasgow coma scale) and there is a sign of cyanosis on the child. There is an increase in the heart rates and air entry is decreased and difficult to hear.
It is advisable not to examine the patient throat as it will precipitate an acute airway obstruction.
Pathologically, croup is caused by inflammation of the mucosa/mucosal inflammation that leads to secretion which affects the larynx, trachea and bronchi. This will leads to narrowing of the subglottic area which cause stridor which is dangerous in young children with narrow trachea.
In term of investigation , it is seldom performed as croup is a clinical diagnosis and blood test may leads to distress to a child.
In case of mild croup most will resolve spontaneously and conservatively manage at home. Paracetamol PRN is useful for symptomatic relief and to reduce temperature. Humidity treatment although popular but is of unproven value in term of medical study.
In case of moderate croup, oral steroid therapy such as prednisolone and dexamethasone and nebulised budesonide are administrated to the patient to reduce the severity and duration of the disease. Observation for 2- 4 hours post administration of steroid is required to watch for any signs of deterioration.
In case of severe croup, nebulised adrenaline 5ml in 1: 1000 with oxygen therapy is required to reduce any upper airway odema as a temporary measure, however further observation is required to avoid any rebound obstruction. Steroid therapy as in moderate croup is adminstrated and the patient may required admission to PICU and intubation.
The complication of croup include acute obstruction of the upper airway which may leads to fatality.
In term of prognosis , the duration of croup is usually up to 2- 3days and occasionally may last for 2- 3 weeks. Around 2- 5% of hospitalized children require intubation.
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