Question

Compare and contrast pathology, clinical presentations and severity of croup and epiglottis.

Answer 1

Ans) Croup

Viral infection of the larynx, trachea, and bronchi, primarily affecting infants and small children, 6 months to 6 years.

Croup (Etiology)
Parainfluenza virus 1(also 2 and 3); less frequently, influenza A and B, respiratory syncital virus, and adenovirus.

Croup (Pathophysiology)
Inflammation & swelling of subglottic structures due to infection. Inc. mucus production & edema due to uneven lymphatic capillary distribution(leading to rapid fluid spreading). V/Q abnormalities can develop leading to hypoxemia.

Clinical manifestations:
Slow onset: 1-2 days of low-grade fever, nasal congestion and coughing. The onset of croup is announced by sever brassy, barking cough, & hoarseness. Usually worsens at night. Stridor can also develop as the extrathoracic airways narrow on inspiration. inspiratory retractions seen below the clavicles and in the intercostal spaces.

The degree of tachycardia and tachypnea determines the severity of croup.

Croup (X-ray findings)
Inc density (haziness) in the subglottic area/ narrowing of trachea/ aka "steeple sign"

Croup (Tx)
Cool mist with O2 PRN and Racemic epinephrine via medication nebulizer, 0.5 ml is given in 3-4 ml of NS, 1-2 hours. Keep child calm. Corticosteroids(0.3 - 0.6 mg/kg of dexamethasone) also reduce the severity and duration of croup, especially in patients where cool mist and epi don't work. Budesonide(aerosolized intranasally) reduces the severity of symptoms

Croup (Tx of severe causes)
Intubation & mechanical ventilation

Epiglottitis
Bacterial infection of the epiclottis and other supraglottic structures in children 2-6 y.o. (sometimes in 8 or 9 y.o.)

Epiglottitis (Etiology)
B Haemophilus influenzae; less commonly, staphylococcus aureus or streptococcus pneumoniae.

Epiglottitis (Pathophysiology)
Inflammation of the epiglottis, aryepiglottic folds, and arytenoids; the epiglottis turns a bright cherry red. Pt has difficulty swallowing, and airway narrowing which is pronounced in during inspiration.

Epiglottitis (Clinical Manifestations)
Symptoms appear abruptly (2-4 hours) & patients appear more acutely ill than with croup. Symptoms are fever, sore throat, and difficulty swallowing which leads to drooling (the most apparent sign of epiglottitis) Stridor and ins retractions are often present. WBC(neutrophils) inc.

Epiglottitis (x_ray signs)
"Thumb sign" showing enlarged and swollen epiglottis

Epiglottitis (Tx)
Don't examine mouth or throat if eppiglottits is suspected. Don't treat with aerosols including racemic epi. O2 is needed, hopsitalize patient, administer ampicillin(200-400 mg/kg/day or chloramphenicol 100 mg/kg/day).

Epiglottitis to extubate:
After a period of 12 hours of no fever