Pediatric Croup, Bronchiolitis and Epiglottitis

Respiratory tract lesions such as pediatric croup, bronchiolitis and epiglottitis comprise a group of acute infections that are not prevalent but can be life-threatening. A majority of such infections are reported in younger children and are easily managed with appropriate care. Pediatric croup is mainly caused by the parainfluenza virus (Kumar & Maitra 2007:537). The disorder consists of the distinctive symptoms of croup: an alarming stridor heard during inspiration and severe persistent cough (Thomas 2006:111).

The infection resolves by itself, but such upper respiratory tract infections are known to facilitate secondary bacterial invasion, especially by streptococci, staphylococci and Haemophilus influenzae (Kumar & Maitra 2007:537). The respiratory syncitial virus (RSV) is the predominant agent of bronchiolitis among infants. Being an inflammation of the bronchioles, it produces a characteristic wheeze and accompanying symptoms of viral infection in the lower respiratory tract: fever, cough and catarrhal inflammation on the mucus membrane in the nose (Welliver 2004:274).

Almost all cases are self-limited and treatment consists mainly of supportive measures (Welliver 2004:281). Epiglottitis consists of cellulitis of the epiglottis and inflammation of the surrounding structures. Haemophilus influenza is the main pathogen implicated, although cases of streptococcal epiglottitis have also been reported (Rubin, Gonzalez & Sande 2007:192). The major findings include pain due to a severe sore throat, high fever and obstruction of airway.

Epiglottitis can have the most devastating effects if patency of the airway is not achieved immediately; the obstruction is abrupt and easily fatal (Kumar & Maitra 2007:537). Even though all three conditions are respiratory tract infections, differences are obvious on clinical presentation. In pediatric croup, the most distinct symptom is the inspiratory stridor. In some cases patients develop fever, rhinitis and pharyngitis which give way to croup (Thomas 2006:111).

In bronchiolitis, the patient presents with findings of upper respiratory tract infection (persistent serous secretions from the nose and cough) which eventually lead to a lower respiratory disease picture with the onset of wheezing (Welliver 2004:276). In bronchiolitis, unlike croup, the barking cough is absent. Epiglottitis patients present with moderate to severe respiratory distress with increased heart rate and systemic toxicity. The patient often drools while leaning forward in the sitting position probably because of impaired function of the epiglottis (Rubin, Gonzalez & Sande 2007:192).

Diagnosis of pediatric croup is mainly clinical, however culture of parainfluenza virus from secretions of the nose, pharynx and lower respiratory tract are the gold standard. Treatment for croup is principally supportive; bronchodilators and steroids may be used but data for their efficacy is scarce (Thomas 2006:111). Specific diagnosis of bronchiolitis can also be reached by culture of RSV; clinical diagnosis is difficult due to the similar presentations of bronchiolitis and infectious asthma. However, a sudden outbreak points towards RSV.

Treatment options include beta-adrenergic blockers and alleviation of hypoxemia by oxygen therapy in the sicker patient (Welliver 2004:279). Epiglottitis can be easily diagnosed on clinical grounds. On direct fiberoptic laryngoscopy, the typical swollen “cherry red” epiglottis can be visualized. Treatment is with antibiotics such as ampicillin/sulbactam, cefuroxime or ceftriaxone for 7 to 10 days (Rubin, Gonzalez & Sande 2007:193). BIBLIOGRAPHY Kumar, V. , & Maitra, A. (2007). The Lung. In Robbins Basic Pathology.

Philadelphia: Saunders. Rubin, M. A. , Gonzales, R. , & Sande M. A. (2007). Infections of the Upper Respiratory Tract. In Harrison’s Principles of Internal Medicine, 16th Edition (p. 1543). New York: McGraw-Hill. Thomas, S. (2006). Viral Pulmonary Infections. In Washington Manual(R) Pulmonary Medicine Subspecialty Consult, The, 1st Edition (p. 119). Philadelphia: Lippincott Williams & Wilkins. Welliver, R. C. (2004). Bronchiolitis and Infectious Asthma. In Textbook of Pediatric Infectious Diseases 5th Edition. Philadelphia: Saunders.

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