What is croup?
Croup, also known as tracheal bronchitis, is a respiratory disease which is usually triggered by an acute viral infection of the upper respiratory tract. The infection causes the inside of the throat swells, making normal breathing is obstructed and the distinctive barking cough, stridor and hoarseness arise. Croup may be associated with mild, moderate or severe symptoms, which at night often worsen. Treatment usually consists of a single dose of steroid that is taken by mouth; adrenaline is sometimes used in severe cases. Hospitalization is rarely needed.
The diagnosis of croup is diagnosed based on clinical findings after possible more serious causes of symptoms excluded, such as epiglottitis or a foreign body in the airways. Other studies - such as blood tests, x-rays and growing coughed up phlegm - are usually not necessary. Croup is a relatively common condition that affects about 15% of the children at any time, usually between the ages of 6 months and 5-6 years. The disease is extremely rare in teenagers and adults. In the past, diphtheria was the leading cause of croup, but the success of vaccination and greatly improved hygiene and living conditions diphtheria in the Western world still mainly of historical significance.
Signs and symptoms of croup
Typical of croup a barking cough, stridor, hoarseness, difficulty breathing, symptoms at night are often worse. The barking cough is often described as the call of a seal or sea lion. The stridor gets worse with excitement or weeping; if there is to hear stridor at rest is that may indicate a dangerous narrowing of the airways. As the croup worsens, stridor may decrease significantly.
Other symptoms include fever, coryza (the symptoms of the common cold) and the withdrawal of the chest. Drooling or a very sick appearance indicate other medical conditions.
Causes of croup
Croup is usually seen as the result of a viral infection. Others the term in a broader sense, and also summarize use laryngotracheitis, spasmodic croup, throat diphtheria, bacterial tracheitis, Laryngo tracheo bronchitis and laryngo tracheo bronchial pneumonitis below. In the first two conditions has been a virus infection with generally lighter symptoms; the last four are the result of a bacterial infection, and gradients are usually more severe.
Viral croup
Viral croup or acute laryngotracheitis is caused in 75% of cases by the para-influenza virus, usually the types 1 and 2. Other viruses that can cause croup, are the influenza virus A and B, measles virus, adenovirus, and respiratory syncytial virus (RSV). Spasmodic croup is caused by the same group of viruses as acute laryngotracheitis, but while lacking the usual symptoms of infection (such as fever, sore throat and an increase in white blood cells). The treatment and the results of the treatment are also the same.
Pathophysiology
The virus that causes croup, leading to swelling of the larynx, trachea and the large bronchi; This is due to the infiltration of white blood cells (in particular, histiocytes, lymphocytes, plasma cells, and neutrophils). Due to the swelling of the airways become narrower; if it takes worse forms, breathing is considerably more difficult and creates the characteristic restless, noisy air flow which is called stridor.
Diagnostics
Croup is a clinical diagnosis. The first step is to rule out other disorders that obstruct the upper airway, such as epiglottitis, a foreign body in the airways, subglottic stenosis, angioedema, retrofaryngeaal abscess and bacterial tracheitis.
There is no standard created an anteroposterior radiographs of the neck / neck, but if that happens then can it be seen a typical narrowing of the trachea, a narrowing called the "steeple sign" because the narrowing below the vocal cords their shape resembles a spire. The "steeple sign 'already shows where the diagnosis should be sought, but missing in half of the cases.
Other research, such as blood samples and virus cultures, is not recommended because such research can cause unnecessary anxiety, making the already compromised respiratory still be taxed more heavily. With the cultivation of viruses, aspirated from the nasopharynx, the exact cause can be confirmed, but this is actually only happens in the context of scientific research. There needs to be given to a bacterial infection when the patient with a standard treatment is not redecorating; in those cases, further investigation may be the way forward.
Seriousness
The most commonly used system for classifying the severity of croup is the Westley-score. This system is mainly used in research rather than in clinical practice. The Westley score is the sum of points assigned to five factors: level of consciousness, cyanosis, stridor, inhalation and retraction of the chest wall. The points are a factor in the table and the final score ranges from 0 to 17.
- A total score of ≤ 2 indicates mild croup. There may be the distinctive barking cough, but there is no stridor at rest.
- A total score of 3-5 is considered moderate croup. The stridor is good to hear, but there are few other symptoms.
- With a total score of 6-11, there is severe croup. Here, too, there are clear stridor, but also a clear withdrawal chest wall.
- A total score ≥ 12 indicates impending respiratory failure. At this stage, the barking cough and stridor may not be apparent.
Croup prevention
Many cases of croup be prevented by vaccination against influenza and diphtheria. Croup once had only to diphtheria, but by diphtheria vaccination programs in the developed world nowadays a rare disease.
Croup treatment
Children with croup are generally kept as quiet as possible. Always be given steroids, and in severe cases adrenaline there. Children with an oxygen saturation of less than 92% get oxygen, and children with severe croup can be admitted to a hospital for observation. If zuursof is needed, "blow" (a source of oxygen to keep the face of the child) is recommended because it causes anxiety in children less than putting an oxygen mask. When people are treated is less than 0.2% of the cases, endotracheal intubation required.
Steroids
Corticosteroids, such as dexamethasone and budesonide, have been shown to in children with what degree of croup, therefore, lead to a better treatment result. Following administration occurs within six hours already relieve the complaints. Corticosteroids work well, whether they are to be given by mouth, parenterally or as an inhalant, but the preference is for administration via the mouth. Usually, no more than one dose necessary, and which is, in general, also be seen as very safe. A dose of dexamethasone of 0.15, 0.3 or 0.6 mg / kg of body weight all appear to work equally well.
Adrenalin
Moderate to severe croup can be temporarily relieved with nebulized epinephrine. Adrenaline usually already gives relief within 10-30 minutes, but the effect often holds only 2 hours. If the condition for 2-4 hours after treatment remains better and there are no other complications, the child can usually return home.
Other treatments
While there are other treatments for croup studied, but none of them has shown that they are useful. Inhalation of hot steam or humidified air is a traditional self-care treatment, but whether it is effective, has not been scientifically proven and is now rarely used. The use of cough medication, which usually dextromethorphan and / or guaifenesin is in, is also recommended. In the past, administration of heliox (a mixture of helium and oxygen) is used in order to alleviate the work of breathing, but there is very little scientific evidence for the usefulness of this treatment. Because croup in most cases is caused by a virus, antibiotics have no sense unless there is a possibility of a secondary bacterial infetie. In those cases, the antibiotics vancomycin and cefotaxime recommended. In severe cases, in connection with influenza A or B anti-viral neuraminidase inhibitors may be administered.
Forecast
Viral croup usually self-limiting, but in very rare cases leading to death due to respiratory and / or cardiac arrest. Symptoms usually renovate within two days wer on, but can keep seven days. Other rare complications include bacterial tracheitis, pneumonia and pulmonary edema.
Epidemiology
Croup occurs in about 15% of children, mostly between the ages of 6 months and 5-6 years. In this age is approximately 5% of hospital admissions on behalf of croup. In rare cases, croup in children aged 3 months or 15 years. The disease affects 50% more men than women, and in the spring the prevalence is highest.
History
The word croup comes from the Early Modern English verb croup, which means 'hoarse cry' means; The term was first used in Scotland and arrived in the 18th century in vogue everywhere. Croup diphtheria has been known since the time of Homer in ancient Greece, but the distinction between croup caused by a virus and croup due to diphtheria in 1826 was only made by Bretonneau. Viral croup was called by the French "faux-croup, while with 'croup' meant a disease caused by the diphtheria bacteria. The advent of effective vaccination is croup due to diphtheria is very rare.