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  2. 2. DEFINITION:Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway.
  3. 3. 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.
  4. 4. 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.
  5. 5. Bacterial causes:Mycoplasma pneumoniae Corynebacterium diphtheriae Staphylococcus aureus Streptococcus pneumoniae Hemophilus influenzae andMoraxella catarrhalis
  6. 6. CLINICAL FEATURES:Initial symptoms- rhinnorhea, mild cough and low grade fever.“Barking" cough-The "barking" cough is often described as resembling the call of a seal or sea lion. Stridor- The stridor is worsened by crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. HoarsenessDifficult breathing which usually worsens at night.Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing.
  7. 7. 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)
  8. 8. CONTD..Nasopharyngeal aspirate- Viral cultureWBC CountClinical diagnosis doneOther investigations are excluded to prevent unnecessary agitation and thus improve the stress.
  9. 9. The Westley Score: Classification of croup severity Number of points assigned for this feature Feature 0 1 2 3 4 5Chest wall None Mild Moderate Severeretraction WithStridor None At rest agitation WithCyanosis None At rest agitationLevel of Normal Disorientedconsciousness MarkedlyAir entry Normal Decreased decreased
  10. 10. 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)
  11. 11. 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.
  12. 12. COMPLICATIONS:Extension of infectious process to other regions of the respiratory tract, e.g. middle ear or pulmonary parenchyma.Bacterial tracheitis
  13. 13. PREVENTION:Many cases of croup have been prevented by immunization for influenza and diphtheria.
  14. 14. 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.
  15. 15. THANK YOU