2025 – PAGE 339 – INFECTIOUS DISEASES
CROUP, TRACHEITIS, AND EPIGLOTTITIS SUMMARY TABLE
| DISEASE | ETIOLOGY | SYMPTOMS | PEARLS | TREATMENT |
| CROUP = VIRAL LARYNGOTRACHEO-BRONCHITIS | – PARAINFLUENZA is the classic one.
– Can also be caused by RSV, Influenza A/B, or other viruses. |
– BARKY, coarse cough.
– Stridor (can be inspiratory and expiratory if severe) – Nontoxic, but do have low grade fever & rhinorrhea (viral-syndrome). |
– Winter
– Can rebound so hospitalize – May prefer sitting up. – May be slightly anxious, but NOT toxic appearing – Usually in kids about 2 years of age – Steeple sign on imaging (AP X-ray!): STEEPLE: www.pbrlinks.com/CROUP1
|
– COOL AIR/MIST
– Use racemic epi if moderate–severe – ± STEROIDS – Bacterial tracheitis is a super-infection with Staphylococcus on top of the croup! |
| SPASMODIC CROUP | – Unknown, but frequently associated with atopic disease. | – Same as above EXCEPT no viral syndrome symptoms (no fever, no rhinorrhea).
|
– Recurrent problem.
– Often at night. |
– Same as above. |
| BACTERIAL TRACHEITIS | – Staph superinfection of CROUP.
|
– COPIOUS MUCOID secretions by a BACTERIA
– Look for a patient < 3 years of age with a croupy cough that QUICKLY deteriorates. – HIGH FEVERS but SUPINE – Often need intubation |
– NO DROOL
– LOOKS BAD, REALLY BAD – PEARL: If URI/barky for 1 day, think croup. If for a few days and SICK, think bacterial tracheitis. – MNEMONIC: After all, what’s going to be worse, a bacterial Staph infection or a “croupid” viral syndrome? (Pronounce croupid like stupid) |
– Anti-Staphylococcus antibiotics
– Nafcillin + cefotaxime (or cefuroxime) |
| EPIGLOTTITIS | – HIB (typable!).
– Can also be caused by Strep or Staph. |
– FEVER, DROOLING, TONGUE PROTRUDING, RAPIDLY TOXIC, RED EPIGLOTTIS, SITTING AND LEANING FWD
– Hydrophobia. ± biphasic stridor (inspiratory AND expiratory) |
– True emergency, rare now
– Thumbprint sign (Lateral X-ray!) – Be prepared to intubate. – IMAGE: www.pbrlinks.com/EPIGLOTTITIS1 Look for a lateral neck X-ray! – MNEMONIC: “A BIG LOT o’ TIDY WHITIES that turned RED/BLOODY. HEY, MOP IT UP PHIL! The real docs are in a rush to go to the OR!” = E-pig-lot-titis, RED epiglottis, Hae-mop-phil-us. |
– Ceftriaxone or cefotaxime to cover Hib and Strep.
– INTUBATE IN THE OR |