Croup

This article is about the respiratory condition. For the part of a quadruped, see rump (animal). For the crop of a bird, see crop (anatomy). For the type of casino employee, see croupier.

Croup
Other namesCroupy cough, subglottic laryngitis, obstructive laryngitis, laryngotracheobronchitis
The steeple sign as seen on an AP neck X-ray of a child with croup
Pronunciation
SpecialtyPediatrics
Symptoms"Barky" cough, stridor, fever, stuffy nose[2]
DurationUsually 1–2 days but can last up to 7 days[3]
CausesMostly viral[2]
Diagnostic methodBased on symptoms[4]
Differential diagnosisEpiglottitis, airway foreign body, bacterial tracheitis[4][5]
PreventionInfluenza and diphtheria vaccination[5]
MedicationSteroids, epinephrine[4][5]
Frequency15% of children at some point[4][5]
DeathsRare[2]

Croup, also known as croupy cough, is a type of respiratory infection that is usually caused by a virus.[2] The infection leads to swelling inside the trachea, which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough, inspiratory stridor and a hoarse voice.[2] Fever and runny nose may also be present.[2] These symptoms may be mild, moderate, or severe.[3] Often it starts or is worse at night and normally lasts one to two days.[6][2][3]

Croup can be caused by a number of viruses including parainfluenza and influenza virus.[2] Rarely is it due to a bacterial infection.[5] Croup is typically diagnosed based on signs and symptoms after potentially more severe causes, such as epiglottitis or an airway foreign body, have been ruled out.[4] Further investigations, such as blood tests, X-rays and cultures, are usually not needed.[4]

Many cases of croup are preventable by immunization for influenza and diphtheria.[5] Most cases of croup are mild and the patient can be treated at home with supportive care. Croup is usually treated with a single dose of steroids by mouth.[2][7] In more severe cases inhaled epinephrine may also be used.[2][8] Hospitalization is required in one to five percent of cases.[9]

Croup is a relatively common condition that affects about 15% of children at some point.[4] It most commonly occurs between six months and five years of age but may rarely be seen in children as old as fifteen.[3][4][9] It is slightly more common in males than females.[9] It occurs most often in autumn.[9] Before vaccination, croup was frequently caused by diphtheria and was often fatal.[5][10] This cause is now very rare in the Western world due to the success of the diphtheria vaccine.[11]

  1. ^ "Croup". Macmillan. Retrieved 1 April 2020.
  2. ^ a b c d e f g h i j Rajapaksa S, Starr M (May 2010). "Croup – assessment and management". Aust Fam Physician. 39 (5): 280–2. PMID 20485713.
  3. ^ a b c d Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  4. ^ a b c d e f g h Everard ML (February 2009). "Acute bronchiolitis and croup". Pediatr. Clin. North Am. 56 (1): 119–33, x–xi. doi:10.1016/j.pcl.2008.10.007. PMID 19135584.
  5. ^ a b c d e f g Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359.
  6. ^ Thompson M, Vodicka, TA, Blair, PS, Buckley, DI, Heneghan, C, Hay, AD, TARGET Programme, Team (Dec 11, 2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ (Clinical Research Ed.). 347: f7027. doi:10.1136/bmj.f7027. PMC 3898587. PMID 24335668.
  7. ^ Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP (10 January 2023). "Glucocorticoids for croup in children". The Cochrane Database of Systematic Reviews. 2023 (1): CD001955. doi:10.1002/14651858.CD001955.pub5. PMC 9831289. PMID 36626194.
  8. ^ Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW (10 October 2013). "Nebulized epinephrine for croup in children". The Cochrane Database of Systematic Reviews. 10 (10): CD006619. doi:10.1002/14651858.CD006619.pub3. PMID 24114291.
  9. ^ a b c d Bjornson CL, Johnson DW (15 October 2013). "Croup in children". CMAJ: Canadian Medical Association Journal. 185 (15): 1317–23. doi:10.1503/cmaj.121645. PMC 3796596. PMID 23939212.
  10. ^ Steele V (2005). Bleed, blister, and purge : a history of medicine on the American frontier. Missoula, Mont.: Mountain Press. p. 324. ISBN 978-0-87842-505-1.
  11. ^ Feigin, Ralph D. (2004). Textbook of pediatric infectious diseases. Philadelphia: Saunders. p. 252. ISBN 978-0-7216-9329-3.