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Croup

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Croup is a severe respiratory condition caused by either a viral infection or bacterial infection. 

Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females.

The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice. It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.  The final score ranges from 0 to 17. 

  • A total score of 1-2 indicates mild croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest
     
  • A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs.
     
  • A total score of 6–11 is severe croup. It also presents with obvious stridor, but also features marked chest wall indrawing.
     
  • A total score of 12 and over indicates impending respiratory failure. The barking cough and stridor may no longer be prominent at this stage. At this stage hallucinations, out of body experiences and even near death experiences may occur

Symptoms

Croup  leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, hoarseness amd severe difficulties in breathing. The "barking" cough is often described as resembling the call of a seal or sea lion.  The stridor is worsened by agitation or crying.  Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing.

Causes

Croup is usually triggered by an acute viral infection of the upper airway. The term Croup is often used to include acute laryngotracheitis, spasmodic croup, laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. The first two conditions involve a viral infection; the last four are due to bacterial infection and are usually of greater severity.

  • Viral croup/acute laryngotracheitis is caused by the parainfluenza virus.  Other viral etiologies include influenza A and B, measles, adenovirus and respiratory syncytial virus (RSV). Spasmodic croup is caused by the same group of viruses as acute laryngotracheitis.
  • Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Laryngeal diphtheria is due to Corynebacterium diphtheriae while bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterial growth. The most common bacteria implicated are Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis
 

Treatment

 
 

Children with croup are generally kept as calm as possible.

In symptom based medicine, steroids are given routinely, with epinephrine used in severe cases.

Children with oxygen saturations under 92% receive oxygen, and those with severe croup may be hospitalized for observation. If oxygen is needed, "blow-by" administration (holding an oxygen source near the child's face) is used as it causes less agitation than use of a mask.

Although the cause is bacteria and viruses, there are few caused based treatments that appear to be available. 

How it works

The infection that causes croup leads to swelling of the larynx, trachea, and large bronchi.   Swelling produces airway obstruction which, in essence is Asphyxiation.

For more details see also Bacterial infection and Viral infection

Related observations