- 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).
- 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.
- 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.
Most patients have an upper respiratory tract infection with some combination of –
- Mild cough
- Low grade fever
After 1-3 days signs and symptoms of upper respiratory tract obstruction become apparent –
- Barking cough
Seal barking like croupy cough is a feature of laryngotracheobronchitis
- 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)
- Chest X-ray in croup (Laryngotracheobronchitis) reveals a characteristic narrowing of the subglottic region called steeple sign.
- 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.
- 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.