Croup natural history, complications, and prognosis: Difference between revisions

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==Overview==
==Overview==
Viral croup is a [[Self-limiting|self-limited]] disease, symptoms lasting up to 7 days. It can very rarely result in death from complete airway obstruction.  
Croup symptoms typically manifest after 2-7 days of [[human parainfluenza virus]] infection. Symptoms will typically last between 24-48 hours; very rarely they will last up to 7 days. They will typically resolve without treatment, excepting the most severe cases that pose the threat of [[respiratory failure]]. Prognosis is good in mild and moderate croup with and without treatment. Severe croup and impending [[respiratory failure]] classifications have poor prognosis, if left untreated, due to life-threatening airway obstruction. With treatment, all manifestations of croup have a good prognosis. Complications of croup stem from airway obstruction, including [[respiratory failure]] and [[respiratory distress]]. They also stem from infections due to [[immunocompromise]] from the causative [[human parainfluenza virus]] and [[corticosteroid]] therapy; these include [[tracheitis|bacterial tracheitis]], [[atelectasis]], [[pneumonia]], [[pulmonary edema]], and [[epiglottitis]].
 
==Natural History==
*The [[incubation]] period for [[human parainfluenza virus]] (HPIV), causing croup, is typically 2 to 7 days upon infection.<ref name="urlHuman Parainfluenza Viruses | Symptoms and HPIV Illnesses | CDC">{{cite web |url=http://www.cdc.gov/parainfluenza/about/symptoms.html |title=Human Parainfluenza Viruses &#124; Symptoms and HPIV Illnesses &#124; CDC |format= |work= |accessdate=}}</ref>
*Croup symptoms will usually develop abruptly post-[[incubation]], often overnight, including simultaneous manifestation of barking cough, [[stridor]], [[hoarseness]], and [[Dyspnea|difficulty breathing]].<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
*Without treatment, mild and moderate croup symptoms will usually resolve within 1 to 2 days of manifestation.<ref name="pmid24335668">{{cite journal |vauthors=Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD |title=Duration of symptoms of respiratory tract infections in children: systematic review |journal=BMJ |volume=347 |issue= |pages=f7027 |year=2013 |pmid=24335668 |pmc=3898587 |doi= |url=}}</ref>
**50% of childrens' symptoms resolve within 24 hours.
**80% of childrens' symptoms resolve within 48 hours.
*Croup is [[Self-limiting|self-limited]] and usually does not require treatment for symptom resolution.
**Threat of [[respiratory failure]] in the most severe cases requires treatment.<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>


==Complications==
==Complications==
*[[Atelectasis]] (collapse of part of the [[lung]])
*Complications that can develop as a result of croup are primarily based on the resultant airway obstruction and include the following:<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
*[[Tracheitis (patient information)|Bacterial tracheitis]]
**[[Respiratory failure]]
*[[Dehydration]]
**[[Respiratory distress]]
*[[Epiglottitis (patient information)|Epiglottitis]]
*Croup complications that can result from [[immunocompromise]] from the causative [[human parainfluenza virus]] include the following:<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
*[[Respiratory arrest]]
**[[Tracheitis|Bacterial tracheitis]]
*[[Respiratory distress]]
***[[Atelectasis]]
**[[Pneumonia]]
**[[Pulmonary edema]]
**[[Epiglottitis]]
*[[Immunosuppressive]] effects from [[corticosteroid]] therapy can also lead to infection-based complications.<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>


==Prognosis==
==Prognosis==
Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by (or confused with) an acute bacterial [[tracheitis]], which is more dangerous. Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema.
*Croup is [[Self-limiting|self-limiting]] and prognosis for croup is usually good, but can vary due to severity of symptoms and complications.
 
===Mild and Moderate Croup===
*Symptoms are not life threatening and will resolve without treatment.<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
**Treatment can shorten the duration of croup and lower the severity of symptoms.<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>
 
===Severe Croup and Impending [[Respiratory Failure]]===
*Symptoms can be life threatening if the severity indicates a possibility of [[respiratory failure]] and will require emergency [[intubation]] for resolution.<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
*Prognosis without treatment, in the presence of possible [[respiratory failure]], is poor.
*Prognosis with proper [[intubation]] in severe croup is good.
 
*The mortality rate for croup is very low at <1 per 100,000 individuals.<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>


==References==
==References==

Revision as of 15:43, 5 February 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

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Overview

Croup symptoms typically manifest after 2-7 days of human parainfluenza virus infection. Symptoms will typically last between 24-48 hours; very rarely they will last up to 7 days. They will typically resolve without treatment, excepting the most severe cases that pose the threat of respiratory failure. Prognosis is good in mild and moderate croup with and without treatment. Severe croup and impending respiratory failure classifications have poor prognosis, if left untreated, due to life-threatening airway obstruction. With treatment, all manifestations of croup have a good prognosis. Complications of croup stem from airway obstruction, including respiratory failure and respiratory distress. They also stem from infections due to immunocompromise from the causative human parainfluenza virus and corticosteroid therapy; these include bacterial tracheitis, atelectasis, pneumonia, pulmonary edema, and epiglottitis.

Natural History

  • The incubation period for human parainfluenza virus (HPIV), causing croup, is typically 2 to 7 days upon infection.[1]
  • Croup symptoms will usually develop abruptly post-incubation, often overnight, including simultaneous manifestation of barking cough, stridor, hoarseness, and difficulty breathing.[2]
  • Without treatment, mild and moderate croup symptoms will usually resolve within 1 to 2 days of manifestation.[3]
    • 50% of childrens' symptoms resolve within 24 hours.
    • 80% of childrens' symptoms resolve within 48 hours.
  • Croup is self-limited and usually does not require treatment for symptom resolution.

Complications

Prognosis

  • Croup is self-limiting and prognosis for croup is usually good, but can vary due to severity of symptoms and complications.

Mild and Moderate Croup

  • Symptoms are not life threatening and will resolve without treatment.[2]
    • Treatment can shorten the duration of croup and lower the severity of symptoms.[4]

Severe Croup and Impending Respiratory Failure

  • The mortality rate for croup is very low at <1 per 100,000 individuals.[2]

References

  1. ↑ "Human Parainfluenza Viruses | Symptoms and HPIV Illnesses | CDC".
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
  3. ↑ Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD (2013). "Duration of symptoms of respiratory tract infections in children: systematic review". BMJ. 347: f7027. PMC 3898587. PMID 24335668.
  4. ↑ 4.0 4.1 Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.

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