Croup

Also Know As Acute Viral Laryngotracheobronchitis (LTB)

Croup

Croup is a condition usually affecting children and is typified by difficulty of breathing and barking cough due to an inflammation in the upper airways. ^[1] The most frequently affected anatomical parts are the larynx and trachea. The bronchi are sometimes involved. Generally, patients fully recover however some cases may be fatal. ^[2]

Epidemiology

Females are more commonly affected than males. The peak age of incidence ranges from 6 months to 3 years old. It becomes unusual after the age of 6 although some cases are recorded among the adolescents and rarely in adults. ^[2]

Causes

Croup may be caused by several entities including viral infection being the most common. Some may be due to bacterial infection. Before croup caused by diphtheria bacteria was fatal until vaccines and modern antibiotics have helped in its deterrence and treatment. Some cases of croup are caused by allergies and acid reflux. ^[3]

Signs and Symptoms

Croup often starts with nonspecific symptoms such as cough, sore throat and runny nose. Fever is usually low and generally after one to two days, the characteristic symptoms are apparent including a harsh, barking cough and hoarseness. As the cough becomes more frequent, the patient usually experiences difficulty of breathing. There can also be a stridor which is a harsh noise heard when the patients inspires air.  The symptoms are worse at night and typically resolve within 3 days to one week. Some may last until 2 weeks. Warning signs indicative of an underlying serious respiratory illness include fast heart beating, fast breathing and bluish discoloration of the skin. ^{[2] [3]}

Diagnosis

The history of the patient which includes the description of symptoms and the physical examination are often the basis for making the diagnosis. Assessing the degree of the severity is done through croup scoring system.  The most commonly used is called Westley score. In some cases, additional laboratory exams are requested including a chest x-ray. ^[3]

Treatment

Croup usually resolves spontaneously in a matter of days. Acetaminophen may be given for fever. Anti-cough medications should be avoided unless it is prescribed by the physician. To help reduce the swelling in the airways, certain medications may be given including corticosteroids. Croup caused by bacteria is treated with antibiotics. Those with severe condition may need to be treated at the hospital. ^[3]

References:

1.      http://www.mayoclinic.com/health/croup/DS00312

2.      http://emedicine.medscape.com/article/962972-overview

http://www.nlm.nih.gov/medlineplus/ency/article/000959.htm

Public Discussion