Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Croup 425

Influenza A/B

RSV

Adenovirus

Rhinovirus

Mycoplasma

Enterovirus

HSV

Reovirus

Signs & Symptoms

■Child initially has mild cold symptoms

■Then ACUTE onset of

➣Dyspnea

➣Croupy cough

➣Inspiratory stridor

■Fever-more likely with some agents than others (e.g., influenza)

■Often fluctuating course

■Auscultation of chest: inspiratory stridor, rales, rhonchi, and/or

wheezing

■Course of croupy cough generally lasts 3–4 days

tests

■WBC is often unremarkable

■Respiratory culture may identify etiology. Multiplex tests, and rapid

PCR tests when widely available, will further help.

Clinical presentation usually sufficient for diagnosis. Presence of

“steeple sign” on PA chest film reflects subglottic narrowing.

differential diagnosis

■Acute epiglottitis; must be distinguished from epiglottitis: generally

lacks croupy cough, in epiglottitis there is a cherry-red epiglottis,

child has characteristic sitting posture in epiglottitis. Also laryngeal

diphtheria, foreign body aspiration, angioneurotic edema.

management

■Mild cases: mostly symptomatic, with close observation

■Pt often responds to moist air.

■Mild sedation at bedtime sometimes used

■Symptomatic

specific therapy

-Mild cases: symptomatic care as above

More severe cases: