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Croup

Disease Details

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Description: Croup is a respiratory condition characterized by a distinctive barking cough, often accompanied by stridor and hoarseness, primarily affecting young children.
Type: Croup is a type of respiratory illness. It is not genetically transmitted; instead, it is typically caused by viral infections, most commonly by the parainfluenza virus.
Signs And Symptoms: Croup is characterized by a "barking" cough, stridor, hoarseness, and difficult breathing which usually worsens at night. The "barking" cough is often described as resembling the call of a sea lion. The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably.Other symptoms include fever, coryza (symptoms typical of the common cold), and indrawing of the chest wall–known as Hoover's sign.Drooling or a very sick appearance can indicate other medical conditions, such as epiglottitis or tracheitis.
Prognosis: Viral croup is usually a self-limiting disease, with half of cases resolving in a day and 80% of cases in two days. It can very rarely result in death from respiratory failure and/or cardiac arrest. Symptoms usually improve within two days, but may last for up to seven days. Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema.
Onset: Croup typically has a rapid onset, often developing over the course of a few days, commonly following symptoms of an upper respiratory infection such as a runny nose and fever. It is most common in children between the ages of 6 months and 3 years.
Prevalence: The prevalence of croup, also known as laryngotracheobronchitis, is approximately 3% of children per year. It is most common in children between the ages of 6 months and 3 years, with a peak incidence at around 2 years of age.
Epidemiology: Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn.
Intractability: Croup is not typically considered intractable. It is a common respiratory condition in children that generally responds well to appropriate treatments such as corticosteroids and nebulized epinephrine. Most cases resolve within a few days to a week. However, severe or recurrent cases may require further medical attention.
Disease Severity: Croup is often a mild to moderate viral infection of the upper airway, leading to swelling around the vocal cords, windpipe, and bronchial tubes. While many cases are mild and can be managed at home, severe cases can cause significant breathing difficulties and may require medical attention or hospitalization.
Healthcare Professionals: Disease Ontology ID - DOID:9395
Pathophysiology: The viral infection that causes croup leads to swelling of the larynx, trachea, and large bronchi due to infiltration of white blood cells (especially histiocytes, lymphocytes, plasma cells, and neutrophils). Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as stridor.
Carrier Status: Croup is not typically associated with a carrier status because it is an acute respiratory condition primarily caused by viral infection, most commonly by the parainfluenza virus.
Mechanism: Croup, primarily a pediatric respiratory condition characterized by a distinctive barking cough, occurs mainly due to viral infections, particularly by the parainfluenza virus.

**Mechanism:**
Croup primarily affects the upper airway, leading to inflammation of the larynx, trachea, and bronchi. The swelling in these regions causes the characteristic symptoms, including a barking cough, stridor (a high-pitched, wheezing sound caused by disrupted airflow), and hoarseness.

**Molecular Mechanisms:**
- **Viral Pathogenesis:** The parainfluenza virus, especially types 1 and 2, infects the epithelial cells of the respiratory tract. The virus binds to the cells via hemagglutinin-neuraminidase proteins and enters the host cells.
- **Immune Response:** Upon infection, the immune system responds by releasing cytokines and chemokines to combat the virus. This response leads to inflammation and edema (swelling) of the airway tissues.
- **Protein Production:** The virus hijacks the host cellular machinery to produce viral proteins, which contribute to the replication and spread of the virus. The resulting cellular damage and immune response exacerbate airway obstruction.
- **Na+/K+ Channels and Water Transport:** Viral infection can affect ion channel function and water transport across cell membranes, contributing to mucosal edema.

Understanding these mechanisms is crucial for developing targeted treatments and managing the symptoms effectively.
Treatment: Most children with croup have mild symptoms and supportive care at home is effective. For children with moderate to severe croup, treatment with corticosteroids and nebulized epinephrine may be suggested. Steroids are given routinely, with epinephrine used in severe cases. Children with oxygen saturation less than 92% should receive oxygen, and those with severe croup may be hospitalized for observation. In very rare severe cases of croup that result in respiratory failure, emergency intubation and ventilation may be required. With treatment, less than 0.2% of children require endotracheal intubation. Since croup is usually a viral disease, antibiotics are not used unless secondary bacterial infection is suspected. The use of cough medicines, which usually contain dextromethorphan or guaifenesin, are also discouraged.
Compassionate Use Treatment: Croup is typically treated with supportive care, corticosteroids, and nebulized epinephrine to reduce airway inflammation and ease breathing. Compassionate use treatments, off-label or experimental options for croup might include:

1. **Heliox Therapy**: This is a combination of helium and oxygen used to reduce airway resistance and work of breathing. Though not a standard treatment, it can be considered in severe cases.

2. **Inhaled Budesonide**: While corticosteroids like dexamethasone are commonly used, inhaled budesonide may be used off-label for its anti-inflammatory effects.

3. **Montelukast**: This leukotriene receptor antagonist is primarily used for asthma but might be explored for its potential in reducing inflammation in croup.

These treatments should be considered with caution and under medical supervision, particularly in a hospital setting.
Lifestyle Recommendations: Lifestyle recommendations for managing croup include:

1. **Humidified Air**: Use a cool-mist humidifier in your child's room to keep the air moist.
2. **Stay Hydrated**: Ensure your child drinks plenty of fluids such as water, broth, or clear soups to prevent dehydration.
3. **Calm Environment**: Keep your child calm and avoid stressing them, as crying can worsen breathing difficulties.
4. **Upright Position**: Have your child sit upright to ease breathing.
5. **Cool Air Exposure**: Briefly exposing your child to cool night air or standing in front of an open freezer can help reduce swelling in the airways.
6. **Monitor Symptoms**: Keep an eye on your child's breathing and be aware of any signs of distress that may require medical attention.

If symptoms persist or worsen, seek medical advice promptly.
Medication: The primary medication used to treat croup is a corticosteroid called dexamethasone, which helps reduce inflammation in the airways. In severe cases, nebulized epinephrine may be administered to quickly decrease airway swelling.
Repurposable Drugs: Repurposable drugs for croup may include:
1. **Dexamethasone**: A corticosteroid that is often used to reduce inflammation in the airway, improving breathing in croup cases.
2. **Epinephrine**: Administered as a nebulized treatment, epinephrine can decrease airway swelling and reduce symptoms of severe croup.

Nanomedicine is not commonly applied for croup treatment, as current therapies are effective and well-established.
Metabolites: Croup is a respiratory condition primarily affecting children. It is characterized by a distinct barking cough and often results from viral infections such as parainfluenza. Specific metabolites associated with croup are not typically a focus in standard clinical assessment or treatment, as the condition is usually diagnosed based on clinical symptoms and presentation rather than metabolic or biochemical markers. Therefore, detailed information on specific metabolites related to croup is not generally emphasized in medical literature. Instead, treatment focuses on alleviating symptoms, primarily through the use of humidified air and corticosteroids in more severe cases.
Nutraceuticals: For croup, there is no established evidence that nutraceuticals (food-derived products with health benefits) are effective in treating the condition. Croup is primarily managed through supportive care, including hydration, humidified air, and medications such as corticosteroids and nebulized epinephrine in severe cases. Always consult healthcare professionals for proper diagnosis and treatment.
Peptides: Croup is not associated with specific peptides that play a known role in its pathogenesis or treatment. Croup, typically caused by viral infections like the parainfluenza virus, affects the upper respiratory tract, leading to a characteristic barking cough, stridor, and respiratory distress. The management of croup focuses on relieving symptoms, often using steroids like dexamethasone and nebulized epinephrine in more severe cases, rather than targeting peptides.