Review Question - QID 103363

A young child presenting with a barking cough and inspiratory stridor is most likely suffering from laryngotracheobronchitis, more commonly called croup. The most common organism is Parainfluenza virus and it should be treated with corticosteroids and racemic epinehprine.

Croup is a viral illness most commonly caused by the Parainfluenza virus. It commonly results in low grade fevers along with a barking cough and inspiratory stridor. Other causes of croup include Enterovirus, Human bocavirus, Influenza A, and Respiratory syncytial virus, though these are far less common. In most children, the symptoms subside quickly within two days, but significant respiratory distress can be seen in rare cases. Due to the need for intubation in cases of respiratory failure, croup is often treated promptly with corticosteroids and racemic epinephrine.

Zoorob et al. discuss croup in their review. They state that croup typically does not lead to high-grade fevers, toxic appearance, or symptoms such as expiratory wheezing, drooling, voice loss, or difficulty swallowing. They also state that neck radiography, though not common, may be considered if the diagnosis unclear as it helps differentiate between croup, epiglottitis, and retropharyngeal processes.

Narayan et al. present factors that affect inpatient hospitalizations in children diagnosed with croup. They state that 49% of all patients admitted to the hospital were administered racemic epinephrine, and 48% were administered intravenous corticosteroids. They also state that patients with history of croup, history of intubation, or with oxygen saturation <95% on presentation all had increased length of stays in the hospital compared with those without these findings.

Illustration A shows subglottic stenosis on an AP radiograph of the neck and cervical spine that can be commonly found in croup.

Incorrect Answers:
Answer 2: RSV is less common cause of croup than Parainfluenza virus. It is the most common cause of upper respiratory illnesses in young children.
Answer 3: Adenovirus is typically responsible for the triad of pharyngitis, conjunctivitis, and fever.
Answer 4: EBV results in pharyngitis with lymphadenopathy combined with fatigue and possible splenomegaly. It does not typically cause croup.
Answer 5: The influenza virus results in higher fevers, myalgias, and fatigue, but does not typically cause croup.