Antibiotics should not be used unless there is evidence of bacterial superinfection. A Cochrane review of the literature found no benefit to the use of antibiotics for acute laryngitis [ 22 ]. Croup is a clinical diagnosis referring to symptoms of acute viral laryngotracheobronchitis or laryngotracheitis, the latter description preferred by some authors [ 23 ].
The clinical presentation is due to acute laryngeal and subglottic swelling and is characterized by the abrupt onset of a barky cough, typically accompanied by hoarseness, inspiratory stridor, and respiratory distress [ 24 ]. Children between the ages of 6 months and 3 years old are most often affected, although some cases occur in children as young as 3 months and rare cases occur in adolescents [ 24 ].
Boys are affected approximately 1. Croup occurs most often in autumn September to December in temperate climates [ 24 ], but cases may occur at any point throughout the year. Parainfluenza virus type 1 is the most common cause of croup and this virus produces epidemics of respiratory illness, including croup, in the fall every other year [ 25 — 27 ]. In North America, odd-numbered years have an increased incidence of croup compared with even-numbered years, as a consequence [ 24 ].
Other major causes of croup include parainfluenza virus types 2 and 3, while less common etiologies include influenza A and B and respiratory syncytial virus [ 25 ]. Human metapneumovirus, adenovirus, and coronavirus cause some cases. Croup is a viral infection that leads to edema of the larynx and trachea; the bronchi may also be involved.
This is most critically manifested by edema within the cricoid ring, which has a fixed circumference as well as being the narrowest region of the pediatric airway.
Significant narrowing in this region can lead to life-threatening airway compromise. The narrowed subglottic region leads to the typical barky cough. The subglottic region of a young child is narrower and more pliable than in older individuals, and the narrowing that occurs with inspiration may be exaggerated in a young child with croup [ 25 ].
Croup usually begins with nonspecific upper respiratory tract symptoms coryza, nasal congestion , but then 12—48 h later there is the abrupt onset of a barky cough. The onset of this cough is usually late at night. Stridor, hoarseness, and fever are other features of the infection. Fever may be high Respiratory distress occurs in varying degrees, depending on the severity of the airway obstruction. In mild cases of croup, stridor is absent at rest but may be present when the child is upset or crying.
Cases classified as moderate to severe croup are associated with stridor at rest and an increasing degree of chest wall retractions although retractions may decrease in severe croup with impending airway failure.
In severe croup, the child is agitated or lethargic. Lateral and anteroposterior AP plain film x-rays can be obtained in stable patients, while maintaining close observation.
Similarly, the lateral film can assist in evaluating for finding associated with alternative diagnoses, such as supraglottis. Most cases of croup are mild, and treatment consists of symptomatic treatment plus a single dose of corticosteroid 0.
A single dose of oral dexamethasone was shown to be beneficial in mild croup in a randomized controlled trial [ 29 ]. Humidified air has a long history of use in treating croup, but there is evidence that it is not effective and should not be used [ 24 ]. Children with moderate to severe croup require evaluation in an emergency department.
Care must be taken to keep the child calm e. Treatment of moderate croup is with a single dose of dexamethasone and oxygen as needed [ 24 ]. Very brief courses of corticosteroids are well tolerated and safe in children [ 30 ]. Treatment of severe croup includes blow-by oxygen optional unless cyanosis is present , corticosteroids, and nebulized epinephrine. The benefit of nebulized epinephrine in respiratory distress is rapid but short term. Onset of the effect starts within 10 min and lasts from 1 to 2 h [ 4 ].
Retreatment with nebulized epinephrine may be required. The diagnosis of bacterial tracheitis should be considered in children with a high fever and a toxic appearance; this diagnosis requires treatment with antibiotics. Epiglottitis and croup can cause sudden and life-threatening loss of the airway, and misdiagnosis or mismanagement can result in fatalities. With appropriate management, however, death from these infections is very rare. Marlene L. Daniel G. Markus Rautiainen, Email: if.
National Center for Biotechnology Information , U. Infections of the Ears, Nose, Throat, and Sinuses. Published online May 4. Guest Editor s : Marlene L. Durand 1 and Daniel G. Author information Copyright and License information Disclaimer. Corresponding author. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. Abstract Epiglottitis, acute laryngitis, and croup acute laryngotracheobronchitis are infections of the upper airway, affecting the epiglottis, larynx, and larynx and trachea, respectively.
Introduction Epiglottitis, acute laryngitis, and croup are infections of the upper airway, affecting the epiglottis, larynx, and larynx and trachea, respectively.
Acute Epiglottitis Supraglottitis Epiglottitis, also called supraglottitis, is an acute infection of epiglottis and surrounding supraglottic tissues that can rapidly lead to life-threatening airway obstruction.
Epidemiology Before the Hib vaccine, the incidence of epiglottitis in children under age 5 years was as high as 15 cases per , population. Pathophysiology The epiglottis is a leaf shaped elastic cartilage with overlying loose connective tissue and a thin mucosa. Microbiology As noted above, H. Clinical Presentation Children Children with epiglottitis typically present with a high fever, inspiratory stridor, restlessness, and drooling.
Adults Symptoms of acute epiglottitis usually develop more slowly in adults than in children. Adults If acute epiglottitis is suspected, patients should be kept in the sitting position and not asked to lie down. Treatment Medical Treatment Empiric antibiotic treatment of acute epiglottitis in children or adults should cover H.
Airway Management Managing the airway is the utmost importance in epiglottitis. Acute Laryngitis Clinical Presentation Acute laryngitis is a common inflammatory disorder of the larynx. Epidemiology Acute laryngitis is the most common disease of the larynx.
Pathophysiology Inflammation of the larynx may involve any area of the larynx, including the supraglottic, glottic, and subglottic areas [ 19 ]. Treatment Because most acute laryngitis cases are due to viruses, treatment is conservative and includes voice rest. Croup Acute Laryngotracheobronchitis Croup is a clinical diagnosis referring to symptoms of acute viral laryngotracheobronchitis or laryngotracheitis, the latter description preferred by some authors [ 23 ].
Pathophysiology Croup is a viral infection that leads to edema of the larynx and trachea; the bronchi may also be involved. Clinical Features Croup usually begins with nonspecific upper respiratory tract symptoms coryza, nasal congestion , but then 12—48 h later there is the abrupt onset of a barky cough.
Treatment Most cases of croup are mild, and treatment consists of symptomatic treatment plus a single dose of corticosteroid 0. Conclusion Epiglottitis, acute laryngitis, and croup acute laryngotracheobronchitis are infections of the upper airway, affecting the epiglottis, larynx, and larynx and trachea, respectively. Contributor Information Marlene L. References 1. Translated by E. Littre Paris: Balliere et Fils, Wurtele P. Acute epiglottitis: historical highlights and perspectives for future research.
J Otolaryngol. Morens DM. Death of a president. N Engl J Med. Disappearance of epiglottitis during large-scale vaccination with Haemophilus influenzae type B conjugate vaccine among children in Finland.
Epiglottitis in Sweden before and after introduction of vaccination against Haemophilus influenzae type b. Pediatr Infect Dis J. Epiglottitis in children, through Effects of Haemophilus influenza type b immunization. Arch Pediatr Adolesc Med. The rising incidence of adult acute epiglottitis and epiglottic abscess.
Am J Otolaryngol. Acute supraglottitis in adults in Finland: review and analysis of cases. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease. Intern Med J. Although both illnesses presented with stridor, the additional presence of drooling had a high sensitivity 0.
Coughing predicted croup but drooling predicted epiglottitis. Additional reliable signs of epiglottitis were a preference to sit, refusal to swallow and dysphagia. Conclusions: Epiglottitis and croup are often confused because they share symptoms and signs including stridor. It occurs due to other bacteria as well. It is a rare condition. But it is a potentially life-threatening infection.
This infection causes rapid swelling of the epiglottis. Symptoms of epiglottitis include trouble swallowing which can result in drooling, changes in the voice, fever, and an increased breathing rate.
Swelled epiglottis can interfere with breathing. Croup is a viral infection that results in the swelling of the larynx, trachea and bronchi. On the other hand, epiglottitis is a bacterial infection that results in inflammation and swelling of epiglottis. So, this is the key difference between croup and epiglottitis. The causative agent of croup is most often a parainfluenza virus.
Epiglottitis is primarily caused by Haemophilus influenza and then by other bacteria. Moreover, croup affects the larynx, trachea and bronchi, while epiglottitis affects epiglottis.
Swelling of trachea, larynx and bronchi can be seen in croup, while inflammation and swelling of epiglottis occur in epiglottitis. Thus, this is another difference between croup and epiglottitis. Croup is not a serious illness, but, epiglottitis is a life threatening illness. Both croup and epiglottitis are illnesses of the upper airway.
Croup is a common pediatric illness caused due to a viral infection. Croup affects the larynx and trachea. The swelling of the larynx and trachea obstructs breathing. Moreover, it produces a barking cough and a high-pitched whistling sound when breathing. It is not a serious illness.
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