Croup syndrome refers to a group of diseases characterized by an acute onset and infectious etiology, causing a brassy cough and inspiratory stridor. The most common form is laryngotracheobronchitis, usually caused by parainfluenza or other viruses in children ages 3 months to 5 years. It presents with a barking cough and inspiratory stridor worse at night and relieved by upright positioning. Treatment involves corticosteroids, epinephrine, and maintaining airway, breathing, and circulation. Acute epiglottitis is a medical emergency typically caused by Hemophilus influenzae type b, presenting with high fever, drooling, difficulty swallowing, and hyperextended neck

1. Croup Syndrome

2. Croup
 Group of diseases
 Acute onset
 Infectious etiology
 Characterized by
 Brassy cough
 Stridor: inspiratory
 Hoarseness
 Respiratory distress

3. Croup
 Laryngotracheobronchitis
 Spasmodic croup
 Acute epiglottitis
 Diphtheretic croup
 Bacterial tracheitis

4. Laryngotracheobronchitis
 Most common form of acute respiratory
obstruction
 Viral:
 Parainfluenzae (1,2,3)
 Influenzae A, B
 Adeno, RSV, Measles

5. Laryngotracheobronchitis
 Age group: 3 mon-5yr
 Peak age 2 yr
 Male>>female
 Common in winter
 F/H + [15%]

6. Clinical features
 Preceded by symptoms of URI
 Rhinorrhoea
 Mild cough
 Low grade fever
 Barking cough
 Hoarseness
 Inspiratory stridor

7. Clinical features
 Worsening of symptoms: during night
 Relieved by
 Crying
 Sitting up/ upright posture

8. Investigation
 Xray neck: Steeple sign
 Narrowing in subglottic area

9. TREATMENT
 CORTICOSTEROIDS
 EPINEPHRINE
 MAINTAIN ABC

10. Acute Epiglottitis
 Supraglottitis
 Medical emergency
 Caused by
 Hemophilous influenzae type b

11. Clinical features
 Usually starts with minor respiratory symptoms
 Rapid progression
 High fever
 Hoarseness
 Stridor
 Resp. distress: retractions
 Difficulty in swallowing
 Drooling of saliva
 Hyperextended neck

12. Clinical features Laryngoscopy:
 “angry red” epiglottis
 Epiglottis : large & inflamed
 Precaution:
 Laryngoscopy/ throat examination should be
done only in controlled environment
 In presence of
 Equipments for securing airway
 Experienced personnel

13. Investigation
 X- ray neck (Lat view)
 Thumb sign

14. TREATMENT
MAINTAIN AIRWAY: TRACHEOSTOMY MAY BE
REQUIRED ( REFER IMMEDIATELY AS SOON
AS DIAGNOSED SEVERE)
BREATHING: O2 BY MASK OR OXYGEN HOOD
ADEQUATE HYDRATION
AVOIDANCE OF PAINFUL
PROCEDURES(LARYNGOSCOPY)
ANALGESICS
SPECIFIC NTIBIOTICS FOR GRAM NEG
COVERAGE

15. DIPHTHERIA

22. Clinical features
DIPHTHERIC CROUP
 Sore throat
 Hoarseness
 Stridor
 Brassy cough
 Toxic look, ill looking
 Lack of fever

23. Clinical features
Pseudomembrane
 Leather like membrane
 Off-white or greyish and
semitransparent
 Adherent, bleeding on
attempt of removal
 Extension beyond faucial
structures
 Presence of respiratory
obstruction

27. DIAGNOSIS

28. Management
General management
Mild disease:
no hospitalization
 Oral antibiotics: penicillin ,erythromycin
 Analgesics, antipyretics
 Counselling about risk factors to parents
Diptheric croup :
 Oxygen- mask/ tent
 Maintain airway patent
 Avoid painful procedures
Refer if features of respiratory distress
 Artificial airway (if reqd.)
[Tracheostomy/ intubation]
Diphtheria (with evidence of resp obstruction)

29.  Adequate hydration
 Analgesics / antipyretics
Cutaneous lesions:
Wound care debridement and cleaning and
dressing

30. Management
Specific management
 Crystalline penicillin
 Anti Diphtheretic Serum

31. prevention
 Immunization:
As pentavalent vaccine at 6,10,14 weeks of life
Isolation of cases and carriers

32. Thank you