Acute Layngo-tracheo-bronchitis

ACUTE LARYNGOTRACHEOBRONCHITIS(CROUP)
  • Laryngotracheobronchitis is the most common infectious cause of obstruction in children usually occurring between the ages of 6 months and 3 years.
  • Male children (boys) are characteristically more frequently involved than females (girls).
Etiology:
  • It is a viral infection most frequently caused by Parainfluenza virus.
  • Other viruses implicated in causaction are RSV, influenza virus, Adneovirus,Coxsackie A and B virus, Rhinovirus.
Pathology:
  • The most characteristic pathological feature is edema formation in the subglottic area
  • The loose areolar tissue in the subglottic area swells up and causes predominant signs of upper airway obstruction.
Presentation:
  • Most patients have an upper respiratory tract infection with some combination of -
  1. Rhinorrhea 
  2. Pharyngitis
  3. Mild cough 
  4. Low grade fever
  • After 1-3 days signs and symptoms of upper respiratory tract obstruction become apparent -
  1. Barking cough 
  2. Seal barking like croupy cough is a feature of laryngotracheobronchitis 
  3. Hoarseness 
  4. Stridor (initially inspiratory than biphasic)
  • Stridor decreases on lying down.
  • Fever is usually low grade (or absent) although may occasionally be high grade.
  • Droolings is characteristically absent and there is no dysphagia (seen in epiglottitis)
Diagnosis:
  • Chest X-ray in croup (Laryngotracheobronchitis) reveals a characteristic narrowing of the subglottic region called steeple sign.
Treatment:
  • Mild symptoms (barking cough but no stridor at rest)
  • Supportive therapy alone with humified oxygen, oral hydration and minimal handling.
  • Moderate symptoms (barking cough with stridor at rest)
  • Active intervention with humified oxygen, Nebulized racemic epinephrine and glucocorticoids (steroids).
  • Severe symptoms (impending respiratory failure)
  • Require an artificial airway (Intubation with endotracheal tube or tracheostomy may be required).
  • Broncoscopy may be required to suck out viscid tracheobronchial secretions.
  • Antibiotics are not routinely indicated in the treatment of Acute Laryngotracheobronchitis. Their use is limited if there is evidence of secondary bacterial infection.
Exam Question
  • Laryngotracheobronchitis is the most probable diagnosis in a 4 year old boy, with three days history of upper respiratory tract infection presenting with stridor, which 
  • decreases on lying down.
  • Laryngotracheobronchitis is caused most commonly by Parainflueza Virus.
  • Seal barking like croupy cough is a feature of laryngotracheobronchitis .
  • Management of Croup includes Oxygen inhalation and Hydration.
  • Steeple sign is seen in Croup.

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