Croup

The word croup refers to acute inflammatory disease of larynx and trachea and includes viral laryngotracheobranchetis, epiglottitis (inflammation of epiglottis) and bacterial tracheitis. (inflammation of trachea).

All these conditions cause acute stridor a noise heard when the child breathes in.

The noise is produced as a result of turbulence when air flows through narrowed airways caused by swelling of the inner lining of the airways due to inflammation.

Viral croup

This usually affects younger children and is common in winter months. Usual viruses causing this are parainfluenza virus, respiratory syncytial virus ( RSV), influenza virus, rubeola virus (measles causing virus) and adeno virus.

Symptoms and signs: The disease starts with fever cough and cold. Fever is usually mild. The cough has a barking quality. In mild disease stridor may be heard after repeated coughing or when the child is agitated.

In severe disease stridor may be heart at rest. There may be in-drawing of the chest (the chest caves in when the child inhales. This is also called as chest retraction).

Treatment of viral croup: Children with mild form may be managed at home. Adequate hydration should be maintained by giving plenty of oral fluids. Drugs to reduce fever may be given.

Epiglottitis

Epiglottitis refers to inflammation of the epiglottis which is one of the cartilages making up the larynx or voice box. Epiglottis plays a vital role in preventing what we drink or eat from entering the airways by closing the entrance to the larynx. To know more about this structure visit human digestive system and larynx .

This condition is quite serious and potentially fatal as the swelling of epiglottis which can extend to surrounding structures like arytenoid cartilages can cause total blockage of the airway. The disease is commonly caused by a bacterium known as Hemophilus Influenza though other bacteria can also be involved.

Symptoms and signs: The onset is usually acute with fever, difficulty is swallowing, drooling of saliva, hoarseness of voice, in-drawing of chest during inspiration and stridor due to turbulence caused by narrowed airway.

Management: It is imperative to maintain the patency of the airway once the diagnosis is made. The surest way to do this is to place a tube inside the trachea (windpipe) a procedure known as endotracheal intubation.

This is done after giving general anesthesia once the patient becomes unconscious using an instrument called laryngoscope the tongue is lifted up with the patient lying down on his back and the vocal cords visualized. The epiglottis is swollen and red. A tube is passed in between the vocal cords and placed in the windpipe. During this procedure culture of the epiglottis is taken.

The patient should be given intravenous fluids, oxygen and intravenous antibiotics (ceftriaxone or another drug from the same group).

Once the swelling of epiglottis subsides the endotracheal tube is removed and the child started on oral fluids. Intravenous antibiotics should be given for 3 days following which oral antibiotics can be started. Treatment should be continued for at least 10 days.

Prognosis: With prompt diagnosis and appropriate treatment complete recovery can be expected.

Prevention: A vaccine is available against Hemophilus Influenza. Please visit childhood vaccination for details.

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