This document discusses croup and related conditions in children. It describes croup as an acute infectious disease characterized by a barking cough and hoarseness or stridor. The most common type is laryngotracheobronchitis, usually caused by parainfluenza virus. It presents with a cough, low fever, and worsening barking cough and stridor at night in children ages 3 months to 5 years. Treatment includes mist therapy, nebulized epinephrine, and steroids. Acute epiglottitis is a potentially lethal condition presenting with high fever, sore throat, and respiratory distress requiring emergency airway management. Acute infectious laryngitis and spasmodic croup are

1. Dr. Zeeshan Ghani
Pediatrics Department
BBH Rawalpindi

2. CROUP

3. Croup:
* Acute infectious disease
* Barklike or brassy cough
*Hoarseness, Inspiratory Stridor

4. Croup Syndrome
1-Laryngotracheobronchitis
2-Acute Epiglottitis
3-Acute infectious laryngitis
4-Spasmodic Croup

5. Laryngotracheobronchitis
Etiology
Parainfluenza virus 75% (type 1,2,3)
Influenza A & B
Adenoviruses
RSV

6. Clinical Features:
* Age 3m – 5 yr
* Male
* Winter
* Rhinorrhea, pharyngitis, mild cough
* Low fever

7. * Barking cough, hoarseness, stridor
* Worse at night
* Resolve completely within a week
* Croup is clinical diagnosis
* X-ray neck shows “steeple sign”
(subglottic narrowing)

8. Treatment (Laryngotracheobronchitis )
Mist / steam therapy
* Mostens airway secretions
* Sooths inflamed mucosa provide comforts
Nebulized epinephrine
* 0.25 ml in 3 ml of normal saline every 20 min

9. Steroids are beneficial
* Dexamethasone 0.6 mg/kg
* Nebulized budesonide
No antibiotics
Hospitalized if
* Progressive stridor
* Stridor at rest
* Respiratory distress
* Cyanosis
* Depressed mental status

10. Acute Epiglottitis:
* Potentionally lethal condition
* Acute fulminating course
* High fever, sore throat, dyspnoea
* Rapidly progressing respiratory obstruction
* Toxic, dysphagia

11. * Laboured breathing
* Drooling
* Hyperextended neck
* Rapidly increasing cyanosis
* Coma

12. Diagnosis:
* “ Cherry red” swollen epiglottis
* X- ray neck lateral – swollen epiglottis
(Thumb sign)
* Lucocytosis

13. Treatment:
* Medical emergency
* Establish an airway
* Nasotracheal intubation or tracheostomy
* Oxygen
* Ceftriaxone or cefotaxime
* Ampicillin + salbectam

14. Acute infectious laryngitis:
* Virususes cause most cases
(Diphtheria is an exception)
* Sore throat, cough
* Hoarseness and loss of voice out of
proportion to systemic features
* Physical examination is unremarkable
* Laryngoscopy shows edema of vocal
cords and subglottis tissue

15. Spasmodic Croup:
Age: 1-3 yr
* Viral prodrome and fever in absent
* Cause is viral or allergic
* Attacks are sudden and at night
* Child awakens with barking cough
* Stridor and hoarseness
* Improves within hours

16. Differential Diagnosis:
1-Bacterial tracheitis
2-Diphtheritic croup
3-Measles croup
4-Foreign body aspiration
5-Retropharyngel or peritonsillar abscess
6-Angioedema
7-Hypocalcemic tetany

17. Thank You