Materiały źródłowe

• #1 Croup – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431070/

  Croup is a common respiratory illness of the trachea, larynx, and bronchi that can lead to inspiratory stridor and barking cough. […] Croup causes swelling of the larynx, trachea, and large bronchi due to infiltration of white blood cells. Swelling results in partial airway obstruction which, when significant, results in dramatically increased work of breathing, and the characteristic turbulent, noisy airflow known as stridor. […] Etiology is most commonly viral, with some cases caused by bacteria. […] Parainfluenza virus most commonly causes viral croup or acute laryngotracheitis, primarily types 1 and 2. […] Bacterial croup is divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. […] Bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis typically begin as viral infections, which worsen due to secondary bacterial growth. […] Croup is typically a clinical diagnosis based on signs and symptoms. […] Croup is most commonly a viral disease.

• #2 Croup – Wikipedia

  https://en.wikipedia.org/wiki/Croup

  Croup is usually deemed to be due to a viral infection. […] The viral infection that causes croup leads to swelling of the larynx, trachea, and large bronchi due to infiltration of white blood cells (especially histiocytes, lymphocytes, plasma cells, and neutrophils). […] Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as stridor.

• #3 Croup: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/962972-overview

  Croup is a common, primarily pediatric viral respiratory tract illness. […] Croup manifests as hoarseness, a seal-like barking cough, inspiratory stridor, and a variable degree of respiratory distress. However, morbidity is secondary to narrowing of the larynx and trachea below the level of the glottis (subglottic region), causing the characteristic audible inspiratory stridor. […] Inflammation and edema of the subglottic larynx and trachea, especially near the cricoid cartilage, are most clinically significant. Histologically, the involved area is edematous, with cellular infiltration located in the lamina propria, submucosa, and adventitia. The infiltrate contains lymphocytes, histiocytes, neutrophils and plasma cells. Parainfluenza virus activates chloride secretion and inhibits sodium absorption across the tracheal epithelium, contributing to airway edema. The anatomical area impacted is the narrowest part of the pediatric airway; accordingly, swelling can significantly reduce the diameter, limiting airflow. This narrowing results in the seal-like barky cough, turbulent airflow, stridor, and chest wall retractions.

• #4 Acute management of croup in the emergency department | Canadian Paediatric Society

  https://cps.ca/documents/position/acute-management-of-croup

  Croup is caused by viral infections of the respiratory tract and most commonly by parainfluenza types 1 and 3 viruses. Other implicated viruses are influenza A and B, adenovirus, respiratory syncytial virus and metapneumovirus. These infections cause generalized airway inflammation and edema of the upper airway mucosa. The subglottic region becomes narrowed, causing upper airway obstruction and the symptoms typically associated with croup. […] The clinical benefit of corticosteroids in croup is well established and should be considered for treating all children presenting with croup and symptoms ranging from mild to severe. Improvement generally begins within 2 to 3 hours after a single oral dose of dexamethasone and persists for 24 to 48 hours. […] Overall, children treated with corticosteroids have fewer return visits or admissions to the hospital. Fully one-half of children with mild croup treated with corticosteroids are unlikely to need further medical care for ongoing symptoms. Their sleep is improved and their parents report less stress.

• #5 Croup > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/croup

  Croup is usually caused by a viral infection. Less commonly, however, it can be caused by a bacterial infection. […] Viruses that can cause croup include: Parainfluenza virus (the most common cause), Flu (influenza virus), RSV (respiratory syncytial virus), Coronaviruses, including SARS-CoV-2, the virus that causes COVID-19, Rhinovirus, Enterovirus, Adenovirus, Human bocavirus, Human metapneumonovirus, Measles. […] Except for Mycoplasma pneumoniae, which can cause a minor illness similar to croup, bacterial infections are rarely the cause of croup. Other bacterial infections, including by Haemophilus influenzae type b (known as Hib) and Cornebacterium diptheriae (the cause of diphtheria), can cause croup, but they are exceedingly rare in the United States due to vaccines. […] Bacterial infections can also occur as a complication or secondary infection in people who have viral croup.

• #6 Patient education: Croup in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/croup-in-infants-and-children-beyond-the-basics/print

  Croup is a common respiratory illness in young children. It is caused by viruses that produce inflammation and swelling in the larynx (voice box) and upper trachea (windpipe) (figure 1). This narrows the space available for air to enter the lungs (figure 2) and causes the typical signs and symptoms of croup, which include hoarseness, a barking cough, and stridor (noisy high-pitched breathing). […] The most common cause of croup is the parainfluenza virus. Other viruses that sometimes cause croup include influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes coronavirus disease 2019 [COVID-19]), rhinovirus (the virus that causes the common cold), respiratory syncytial virus (RSV), and adenoviruses. These viruses are common causes of upper respiratory infections in children, and they do not always cause croup.

• #7 Croup | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20142

  Croup causes swelling of the larynx, trachea, and large bronchi due to infiltration of white blood cells. Swelling results in partial airway obstruction which, when significant, results in dramatically increased work of breathing, and the characteristic turbulent, noisy airflow known as stridor. […] Etiology is most commonly viral, with some cases caused by bacteria. […] Parainfluenza virus most commonly causes viral croup or acute laryngotracheitis, primarily types 1 and 2. […] Bacterial croup is divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. […] Laryngeal diphtheria is caused by Corynebacterium diphtheriae. Bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis typically begin as viral infections, which worsen due to secondary bacterial growth. […] The common bacterial causes are Staphylococcus aureus, Streptococcus pneumoniae, Hemophilus influenzae, and Moraxella catarrhalis.

• #8 croup | Calgary Guide

  https://calgaryguide.ucalgary.ca/croup/croup-2022/

  Croup: Pathogenesis and clinical findings Viral pathogen (parainfluenza, respiratory syncytial virus, influenza virus, measles morbillivirus, or adenovirus) colonizes the nasopharyngeal mucosa […] Virus migrates along epithelium and invades the upper airways in the larynx and trachea […] Cytokines disrupt hypothalamic thermoregulation […] Host immune response to virus inflammatory cytokine release into circulation […] Immune cells migrate to sites of infection and produce free radicals to fight off virus […] Damage to healthy cells within the upper airways […] Permeability of blood vessels within the upper airways […] Ciliary cells (responsible for clearing mucous and dirt from the respiratory tract) […] Diameter of trachea […] tracheal wall collapses (Bernoullis principle)

• #9 Croup: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/155932

  Croup is an inflammation of the larynx and trachea, mostly seen in young children. A barking cough, varying degrees of airway obstruction, and hoarseness are the defining symptoms. […] The barking cough that is characteristic of croup results from swelling and inflammation around the vocal chords and windpipe. […] Acute croup is most often caused by a virus, as is recurrent, or spasmodic, croup. […] Some researchers argue that spasmodic croup may be linked to allergens such as pollen or a bee sting, or that it may be an allergic reaction to viral antigens, rather than a direct result of a viral infection. […] Types 1, 2, and 3 of the human parainfluenza virus account for 80 percent of all cases of croup. […] Viral infection typically takes the following course to develop into croup: The virus infects the nose and throat. The virus spreads along the back of the throat to the larynx and trachea. As the infection progresses, the top part of the trachea becomes swollen. The space available for air to enter the lungs becomes narrower. Children compensate for this by breathing more quickly and deeply, leading to croup symptoms. The child may become restless or anxious as breathing becomes more difficult. This agitation can also narrow the throat, increase breathing difficulties and worsening the agitation. The effort required to breathe faster and harder is tiring, and, in severe cases, the child may become exhausted and unable to breathe on their own. […] Bacterial infection usually affects the same areas as a viral infection but is typically more severe and requires different treatment. […] Most instances of bacterial croup, more commonly called bacterial tracheitis, are due to secondary bacterial infection from Staphylococcus aureus (S. aureus).

• #10 Croup | Concise Medical Knowledge

  https://www.lecturio.com/concepts/croup/

  Croup is commonly caused by a virus (75% of cases) and less commonly by bacteria. […] Viruses that cause croup infect the nasal and pharyngeal mucosal epithelia through aerosol droplets. […] Infection triggers the infiltration of white blood cells, especially histiocytes, neutrophils, plasma cells, and lymphocytes. […] Leads to swelling that partially obstructs/narrows the airway (anatomic hallmark of croup). […] Heavy breathing during exercise and other vigorous physical activities results in stridor.

• #11 Croup pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Croup_pathophysiology

  Development of croup results from infiltration of white blood cells through the human parainfluenza virus (HPIV). The inflammation response to HPIV occurs from the up-regulation of cytokines and the released Immunoglobulin E inhibiting histamine. The resultant swelling of the larynx, trachea, and large bronchi obstructs the airways, which leads to croup. […] Development of viral croup results from infiltration of histiocytes, lymphocytes, plasma cells, and neutrophils white blood cells primarily by human parainfluenza viruses (HPIV). […] The infiltration from HPIV causes inflammation by the up-regulated production of cytokines, localized in the trachea. […] Additionally, HPIV-response Immunoglobulin E (IgE) release has been found to inhibit histamine, contributing to the inflammation that causes croup. […] Of the four different serotypes, HPIV-1 and HPIV-2 are the serotypes that cause croup.

• #12 Croup and Bronchitis

  https://www.atsu.edu/faculty/chamberlain/website/lectures/lecture/resairin.htm

  Viral infection of the upper airways causes inflammation and edema of the larynx in acute laryngitis, and viral infection in the larynx, trachea, and bronchi causes viral croup. Mucus is produced by the host and causes partial obstruction of the airway in both viral croup and acute laryngitis. Swelling of the vocal cords results in dysphonia. In viral croup, narrowing of the subglottic trachea in a child’s airway results in audible inspiratory stridor. As viral croup progresses, the lumen of the trachea becomes obstructed further by fibrous exudates. The barking cough that occurs in patients with viral croup is caused by inflammation in the larynx and trachea. […] Epiglottitis is a cellulitis of the epiglottis and the surrounding tissues. H influenzae type b colonizes the pharynx. The type b capsule prevents phagocytosis of the bacterial invaders. The organisms then colonize the epiglottitis and enter the tissues of the epiglottitis through minor breaks in the mucosal surface. The organisms grow in the tissues and cause an inflammatory response that result in erythema and edema. A sore throat rapidly progresses to difficulty breathing, stridor, obstruction of the airways, and respiratory arrest. Local extension from the colonized nasopharynx through soft tissues is likely to be the cause of epiglottitis.

• #13 Croup: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/962972-overview

  In severe disease, fibrinous exudates and pseudomembranes may develop, causing even greater airway obstruction. Hypoxemia may occur from progressive luminal narrowing and impaired alveolar ventilation and ventilation-perfusion mismatch. […] Spasmodic croup (laryngismus stridulus) is a noninfectious variant of the disorder, with a clinical presentation similar to that of the acute disease but typically without fever and with less coryza. This type of croup always occurs at night and has the hallmark of reoccurrence in children; hence it has also been called recurrent croup. In spasmodic croup, subglottic edema occurs without the inflammation typical in acute viral disease. Although viral illnesses may trigger this variant, the reaction may be of allergic etiology rather than a direct result of an infectious process.

• #14 Pulsenotes | Croup notes

  https://app.pulsenotes.com/specialities/paediatrics/notes/croup

  Croup is most commonly caused by Parainfluenza virus. […] Viruses initially infect the nasopharyngeal mucosa and then extend towards the larynx and subglottic airways. […] The initial location of infection in croup is the nasopharyngeal airways. Here, the virus multiples and the infection extends distally to affect the larynx and subglottic airways. […] Inflammation of larynx and subglottic airways leads to swelling and airway obstruction, which causes the stridorous breathing. The major problem arises due to the cricoid cartilage. This is a complete cartilaginous ring that is unable to expand to counteract the inflammatory process. This leads to significant airway narrowing and respiratory distress. […] Direct visualisation of the mucosa of the larynx and subglottic airways during acute croup shows typical inflammation including erythema, swelling, mucosal oedema and exudate (collection of fluid and inflammatory cells).

• #15

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/peds-em-curriculum/respiratory/croup

  Laryngotracheobronchitis, better known as croup, causes subglottic inflammation and edema resulting in laryngeal obstruction and narrowing of the airways. Croup is the most common cause of upper airway obstruction in pediatrics. The swelling at the cricoid ring (narrowest part of the pediatric airway) results in symptoms of upper airflow obstruction (stridor) and subsequently respiratory distress. […] The peak incidence of croup is in the fall and winter months. In a toddler, only 1mm of edema will result in a 65% reduction of the cross-sectional area in the subglottis. […] The clinical features of croup include a two-three day history of upper respiratory symptoms with progressively worsening cough, especially at night. On day three or four, the classic triad of hoarseness, stridor, and barky cough is heard.

• #16 Epiglottitis and Croup | Ento Key

  https://entokey.com/epiglottitis-and-croup/

  Croup is typically caused by respiratory viruses, with parainfluenza I, II, and III accounting for up to 80% of cases. […] The virus is transmitted through inhalation and infects the epithelial cells of the laryngeal and tracheal mucosa, causing edema and glandular hypersecretion. […] Even 1 mm of edema in the normal pediatric subglottis reduces its area by more than 50%. […] The subglottis is the only region of the airway bounded by a complete cartilaginous ring that prevents the airways outward expansion in the face of edema. […] Numerous mucus-secreting glands lie within the subgottis mucosa. […] The role of supraesophageal reflux in the pathogenesis of croup remains unclear. […] A study by Contencin and Narcy demonstrated that 100% of eight patients who had recurrent croup had pH probe studies consistent with reflux.

• #17 Croup: Clinical features, evaluation, and diagnosis – UpToDate

  https://www.uptodate.com/contents/croup-clinical-features-evaluation-and-diagnosis

  Croup is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. These symptoms result from inflammation in the larynx and subglottic airway. […] Croup is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. These symptoms result from inflammation in the larynx and subglottic airway. […] Viral croup (also called classic croup) refers to the typical croup syndrome that occurs most commonly in children six months to three years of age. As the name implies, it is caused by respiratory viruses and so viral symptoms (eg, nasal congestion, fever) are usually present. Viral croup is usually a self-limited illness; the cough typically resolves within three days.

• #18 Patient education: Croup in infants and children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/croup-in-infants-and-children-beyond-the-basics/print

  Bacterial infection of the same area (which is called bacterial tracheitis) is a rare complication of croup that can occur during or following viral croup. Bacterial tracheitis is a more severe illness and requires a different treatment than viral croup. […] Dexamethasone is the preferred glucocorticoid medication for treating moderate to severe croup. It is a long-acting medication that works by decreasing inflammation in the airway. It starts to work within four to six hours of the first dose. […] Dexamethasone has been shown to reduce signs of respiratory distress in children with croup. It also reduces the need for hospital admission and decreases the duration of the stay in the hospital. […] Inhaled epinephrine is given by nebulizer (an inhaled mist) to children with moderate to severe croup. It is a quick-acting medication that can rapidly reduce airway swelling. The effect is short-lived, lasting only two hours or less. Retreatment may be needed.

• #19 Croup – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348

  Croup refers to an infection of the upper airway, which becomes narrow, making it harder to breathe. Croup also causes a cough that sounds like barking. […] The cough and other signs and symptoms of croup are the result of swelling and irritation around the voice box (larynx), windpipe (trachea) and bronchial tubes (bronchi). When a cough forces air through this narrowed passageway, the swollen vocal cords produce a noise like a seal barking. Taking a breath often produces a high-pitched whistling sound called stridor. […] When the upper airway is infected with the virus that causes croup, tissues around the voice box (larynx) and the windpipe (trachea) will swell. […] Croup is usually caused by a viral infection, most often a parainfluenza virus. […] Most cases of croup are mild. In a small number of children, the airway swells enough to cause problems with breathing. Rarely, a bacterial infection of the windpipe can occur in addition to the viral infection. This can result in trouble breathing and requires emergency medical care.

• #20 croup | Calgary Guide

  https://calgaryguide.ucalgary.ca/croup/croup-2022/

  Immature/less rigid tracheal walls in young children susceptible to further structural narrowing […] Breathing across a narrowed trachea turbulent airstreams […] Inspiratory stridor […] Expiratory […] Children rely on compensatory respiratory mechanisms as they fatigue overtime (harsh, high- barking cough pitched sound) […] Respiratory distress […] Nasal flaring […] Chest-wall in-drawing […] Tachypnea […] Accessory respiratory muscle use.

• #21 PATHOGENESIS OF PARAINFLUENZA VIRUS (PV)-INDUCED CROUP: ROLE OF DEFICIENT REGULATION OF CELL-MEDIATED IMMUNE RESPONSE AND IGE PRODUCTION | Pediatric Research

  https://www.nature.com/articles/pr19841121

  We studied children with croup (C) or upper respiratory illness (URI) alone due to PV to determine if abnormalities of immune regulation play a role in the pathogenesis of C. […] Reduced function of a suppressor cell regulating both IgE production and lymphoproliferative responses to PV antigen may underlie the pathogenesis of PV-induced croup, and links this disease to bronchiolitis and to atopic disease states.

• #22

  https://turkjpediatr.org/article/view/987

  The aim of this study is to investigate the role of cytokines (TNF-, IL-6, IL-10, and PAF), cortisol, and IgE in the pathogenesis of croup and the factors determining its clinical severity. […] Increased levels of IL-10 and cortisol in the moderate/severe group indicate that different systemic and local mechanisms may play a role in the pathogenesis of croup.

• #23 Croup: pathogenesis and management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/6386967/

  Croup syndromes are common in children, most frequently being infectious in origin. […] Management is primarily dependent upon administration of humidified air. Children with moderate to severe croup benefit from racemic epinephrine and steroids. […] Admission is indicated in children with stridor at rest, evidence of exhaustion, toxicity or respiratory distress. Active airway intervention is rarely required but may be life saving if obstruction develops.

• #24 Croup: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0501/p575.html

  Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. […] Viral infection of the subglottic region and laryngeal mucosa causes inflammation and edema, which significantly decrease air movement and lead to respiratory distress and stridor. […] Corticosteroids are thought to work by decreasing laryngeal mucosal edema through their anti-inflammatory effects. […] Epinephrine is thought to improve symptoms in patients with croup through arteriole vasoconstriction in the upper airway mucosa, which eventually leads to decreased edema.

• #25 Croup: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/8277-croup

  Croup causes swelling of your childs voice box (larynx) and windpipe (trachea). […] Croup causes swelling of your childs voice box (larynx) and windpipe (trachea). This swelling causes the airway below their vocal cords to narrow, which makes their breathing noisy and difficult. […] The most common cause of croup is a viral infection. Croup viruses include parainfluenza, influenza, respiratory syncytial virus (RSV), measles and adenovirus. Viral croup causes your childs upper airways to swell, making it difficult for them to breathe. However, these viruses are common and most children with viral infections dont develop croup. Rarely, bacteria can complicate the viral infection and make it more difficult to breathe. […] Glucocorticoids are a type of steroid that decreases the swelling of your childs voice box (larynx), typically within six hours of the first dose. […] Your child will receive epinephrine as an inhaled mist (nebulizer). This also reduces the swelling in your childs airways and usually starts working within 10 minutes.

• #26 Croup – Evidence Based Strategies – November 2022 | Children’s Mercy Kansas City

  https://www.childrensmercy.org/health-care-providers/refer-or-manage-a-patient/connect-with-childrens-mercy/newsletter-the-link/evidence-based-strategies-for-common-clinical-questions-november-2022/

  Croup, or viral laryngotracheitis, is an upper airway inflammatory process most commonly due to parainfluenza virus type 1 affecting children from 3 months to 6 years of age. […] Inflammation impedes the typical laminar flow through the larynx and trachea. The increase in resistance creates turbulent air flow which contributes to the high-pitched inspiratory sound appreciated during the physical exam. […] Systemic steroids have been used to treat croup since the 1980s. They work to reduce local inflammation thus decreasing air flow resistance. […] Racemic epinephrine is an alpha-1 agonist with rapid onset causing vasoconstriction and thus leading to decreased airway inflammation. […] Heliox is reserved for patients with severe croup. It is most commonly a blended mixture of 80% helium/20% oxygen or 70% helium/30% oxygen. Helium is a less dense air molecule, thereby improving oxygen delivery by promoting laminar flow.

• #27 Acute management of croup in the emergency department | Canadian Paediatric Society

  https://cps.ca/documents/position/acute-management-of-croup

  Nebulized epinephrine is recommended for moderate to severe croup. Reports of administering epinephrine in children with severe croup have demonstrated a lower number of cases requiring intubation or tracheotomy. […] A heliox or helium-oxygen mixture can reduce respiratory distress in children with severe croup. A possible mechanism of action is that the lower density of helium gas decreases airflow turbulence in a narrowed airway. Heliox is occasionally used in severe cases to avoid intubation.

• #28

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/peds-em-curriculum/respiratory/croup

  Croup severity can be classified based on the stridor. If there is no stridor at rest, the croup is mild. Croup is moderate severity if stridor is heard only with exertion or when the child is upset. If there is stridor at rest, it is considered severe and typically results in respiratory distress. […] The posterior-anterior chest x-ray may show the classic steeple sign in croup, which indicates subglottic narrowing secondary to edema. […] After airway management and supplemental oxygen, initial treatment includes: Dexamethasone: Any child who presents with croup should receive steroids. There is evidence for decreased admission rates, intubation rates, and emergency department (ED) re-visits if steroids are given. […] Racemic Epinephrine: Any child with severe croup should receive racemic epinephrine. This means anyone with stridor at rest or any patient with croup who appears ill or in distress. […] Helium’s low density and viscosity help improve laminar gas flow. This mixture may prevent intubation.

• #29 Croup – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/respiratory-disorders-in-infants-and-children/croup

  Croup is caused by a viral infection that leads to swelling of the lining of the airways, particularly the area just below the voice box (larynx). […] The most common cause of croup is Parainfluenza viruses. […] Croup can also be caused by other viruses, such as respiratory syncytial virus (RSV) or an influenza virus. Croup caused by an influenza virus may be particularly severe and may occur in a broader age range of children. […] Croup usually starts with symptoms of a cold runny nose, sneezing, mild fever, and some coughing. Then the child develops hoarseness and a frequent, unusual-sounding cough, which is described as brassy or barking. […] Croup ranges widely in its severity. Sometimes swelling of the airway causes difficulty breathing, which is most noticeable when breathing in (inspiration). In severe croup, there may be a loud squeaking noise (stridor) heard with each inspiration.

• #30 Adult croup caused by influenza A virus: a case report and literature review – Canales-Azcona – Journal of Emergency and Critical Care Medicine

  https://jeccm.amegroups.org/article/view/8717/html

  Approximately 80% of the detectable causes of pediatric croup cases are viral. […] Nevertheless, influenza virus, although considered an infrequent cause of croup, has been associated with longer hospital stays and an increased risk of readmission for recurrence of laryngeal symptoms. […] IAV is divided into subtypes according to their two surface proteins, hemagglutinin (HA or H) and neuraminidase (NA or N), with 18 and 11 different subtypes, respectively. […] It is through this hemagglutinin glycoprotein that the IAV binds to receptors on the surface of respiratory epithelial cells and initiates infection. […] The diagnosis of influenza is based on clinical signs and local epidemiological data, yet laboratory testing is often necessary due to non-specific symptoms. […] AC represents a more severe disease, some authors suggest that it is a criterion for admission to the ICU when available. […] Although there is no consensus that provides recommendations for adult cases, treatment of croup, regardless of etiology, is aimed at symptomatic relief by decreasing subglottic inflammation through the administration of glucocorticoids and nebulized epinephrine without delay.

• #31 Stridor in Children – Diagnostic Algorithm and Treatment – Manual of Medicine

  https://manualofmedicine.com/topics/emergency-acute-medicine/stridor-in-children-diagnostic-algorithm-and-treatment/

  Croup – Pathogenesis and Clinical Findings […] General […] Peak incidence in 1-2 year […] Organisms: Parainfluenza I (most common-80%), II and III, M. pneumoniae, RSV, Influenza (severe form), adenovirus […] Clinical features of Croup […] Age: 6m-4y; Season: fall-winter […] Viral prodrome […] Barky cough, hoarse (subglottic airway narrowing) […] Fever: common in croup, but usually not toxic […] Lateral Neck Xray: Steeple sign (non-specific finding) […] Symptoms peak over 2 days and resolve over 1 week […] Croup score: mild (0-4), mild/mod (5-6), moderate (7-8), severe (9-14), terminal (15) […] Treatment of Croup […] Steroids […] Indication: all croup in the ED? […] Decreased mortality for croup from 1/200 to 1/30,000 […] Multiple studies show efficacy, associated with a decrease in ED stay and ED bounce backs

• #32 Corticosteroids for Croup – Don’t Forget the Bubbles

  https://dontforgetthebubbles.com/corticosteroids-for-croup/

  Dexamethasone was associated with fewer hospital admissions and return visits compared to prednisolone. […] Oral dexamethasone is the most practical and effective route of administration of corticosteroids. Other routes can be cautiously considered if oral dexamethasone is not tolerated. […] Overall, the evidence suggests that the efficiency of dexamethasone for moderate croup tails off at 0.15mg/kg. […] Corticosteroids are more effective than a placebo for treating croup within the first 24 hours. Dexamethasone is the most efficient, palatable, and best-tolerated corticosteroid. Doses of 0.15mg/kg of dexamethasone are recommended regardless of the severity of croup. In children with life-threatening croup, consider higher doses of dexamethasone alongside nebulised adrenaline and airway management.

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