Croup is defined as a lower respiratory tract infection (LRTI) characterized by brassy cough, often (not always) accompa- nied by stridor, hoarseness, and respiratory distress.
Epiglottitis
It is an emergency characterized by URTI, fever, dysphagia, noisy breathing, brassy cough, and respiratory distress with chest retractions (including suprasternal).
Etiologic pathogen is usually Hib though some cases may be caused by Staphylococcus aureus, group A streptococci, and Streptococcus pneumonia. Treatment comprises antibiotics to cover Hib (cefotaxime, ceftriaxone), humidified oxygen, and adequate hydration. Intubation and tracheostomy and even short-term ventilation may be needed in some cases. Prognosis with timely treatment is good.
Laryngotracheobronchitis (Infectious Croup)
It is characterized by URTI followed by brassy cough, stridor, respiratory distress with chest retractions (sternal and suprasternal), restlessness from hypoxemia, and cyanosis. Etiologic pathogens are invariably viruses (parainfluenza type 1, RSV, parainfluenza types 2 and 3, influenza virus, adenoviruses, rhinoviruses).
Treatment comprises humidified oxygen, adequate hydration, and nebulization with epinephrine and/or intramuscular (IM) injection dexamethasone. Readiness for intubation, tracheostomy, and even ventilator support in severe cases is advisable.
Spasmodic Croup
It is characterized by sudden onset of brassy cough and stridor, sometimes preceded (not always) by an URTI. It subsides without any treatment within a few hours, though recurrence may be there in the subsequent days. Etiology remains unclear. Treatment comprises nursing of the child in a well-humidified room.
