In 75% of cases, the parainfluenza virus, mainly types 1 and 2, causes croup. Other viruses that can cause croup include influenza A and B, measles, adenovirus and respiratory syncytial virus (RSV). Spasmodic croup (croup with barking) does not have the usual signs of infection, such as fever, sore throat, and increased white blood cell count). Treating spasmodic croup is the same as treating regular croup.
Bacterial croup includes laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. "Corynebacterium diphtheriae" causes laryngeal diphtheria; bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis come from a virus infection, followed by a bacteria infection. The most common bacteria that cause croup are"Staphylococcus aureus", "Streptococcus pneumoniae", "Hemophilus influenzae", and "Moraxella catarrhalis".
Croup is diagnosed based on signs and symptoms. The first step is to make sure it is not another condition that can block the upper airway, especially epiglottitis (an inflammation of the tissue that covers the trachea or windpipe) , something in the airway, subglottic stenosis (narrowing of the airway below the vocal cords), angioedema (swelling underneath the skin), retropharyngeal abscess (pus in the back of the throat), and bacterial tracheitis (bacterial infection in the trachea).
An X-ray of the neck is not routine, but if it is done, it can show a narrowing of the trachea, called the steeple sign, because the narrow shape looks like a church steeple. The steeple sign does not appear in half of cases.
Blood tests and viral cultures (tests for the virus) can cause irritate the airway. Cultures of the virus, obtained by nasopharyngeal aspiration (using a tube to suck mucus out of the nose), are used to confirm the exact cause. These cultures are restricted to people doing research. If a person does not improve with standard treatment, further tests can be done to check for bacteria.
Severity
The most common system for describing the severity of croup is the Westley score. This test is used for research, but does not help the person with croup. Points are given for five factors: level of consciousness, cyanosis (blue skin coloring), stridor (wheezing), air entry, and retractions (skin on the chest pulling in). The table to the right lists the points given for each factor; the final score ranges from 0 to 17.
85% of children going to the emergency department have mild disease. Severe croup is rare–less than 1% of cases.
Immunization (vaccines) for influenza and diphtheria can prevent croup.
It is important to keep children with croup as calm as possible. Children often are given steroids, but epinephrine is used in severe cases. If the amount of blood oxygen is under 92%, the child needs oxygen. People with severe croup can be hospitalized for observation. If oxygen is needed, "blow-by" administration (holding an oxygen source near the face of the child) is better than an oxygen mask, because it is less likely to upset a child than an oxygen mask is. With treatment, less than 0.2% of people need endotracheal intubation(a tube placed into the airway).
Corticosteroids, such as dexamethasone and budesonide, can be used to treat croup. People begin to improve a lot within six hours after taking steroids. Steroids work when given by mouth, injection, or inhalation (breathing them in), but taking them by mouth is best. Most of the time, a single dose is enough. Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally good.
Moderate to severe croup can be helped with nebulized epinephrine(an inhaled solution that widens the airway). While epinephrine reduces croup severity within 10–30 minutes, the benefits last for only about 2 hours. If symptoms improve for 2–4 hours after treatment and no other complications happen, the child typically can leave the hospital.
There is not enough evidence that other treatments for croup are helpful. Clinical studies do not show that breathing hot steam or humidified air is helpful and currently it rarely is used. Medical professionals do not want people to use cough medicines, which containdextromethorphan and/or guiafenesin. Clinical studies also do not support inhaling heliox (a mixture of helium and oxygen) to make it easier to breath. Since most cases of croup is are diseases, antibiotics are not used unless bacteria are also suspected. The antibiotics vancomycin and cefotaxime are recommended for bacterial infections. In severe cases associated with influenza A or B, theanti neuraminidase inhibitors can be given.
Most of the time, croup caused by a virus is a short-term disease. Croup rarely causes death from respiratory failure and/or cardiac arrest. Symptoms improve within two days, but can last for up to seven days. Other uncommon complications include bacterial tracheitis (infection of the trachea), pneumonia (lung infection), and pulmonary edema (fluid in the lungs).
About 15% of children between the ages of 6 months and 5–6 years will get croup. Croup accounts for about 5% of hospital admissions for this age group. In rare cases, children as young as 3 months and as old as 15 years have croup. Males are affected 50% more frequently than are females; croup is more common in autumn (fall).
The word "croup" comes from the Early Modern English verb "croup," meaning "to cry hoarsely"; the name was first used for the disease in Scotland. Diphtheritic croup has been known since the time of Homer's Ancient Greece. In 1826, Bretonneau distinguished croup from a virus and croup due to diphtheria. The French called croup from a virus "faux-croup," using "croup" for a disease caused by the diphtheria bacteria. Croup due to diphtheria has become nearly unknown since most people are immunized.
List of rivers of the Netherlands
These are the main rivers of The Netherlands. All of the Netherlands is drained into the North Sea. At the end of this article the rivers of the Netherlands are listed by the letter.
Aa, Afgedamde Maas, Amer, Amstel, Beneden Merwede, Bergse Maas, Berkel, Bijlands Kanaal, Boven Merwede, Dieze, Dinkel, Dintel, Dommel, Dordtsche Kil, Ems, Geleenbeek, Gender, Geul, Gouwe, Grevelingen, Haringvliet, Hollands Diep, Hollandse IJssel, IJssel, Jeker, Keeten-Mastgat, Krammer, Kromme Rijn, Lauwers, Lek, Linge, Mark, Meuse, Nederrijn, Niers, Nieuwe Maas, Nieuwe Merwede, Nieuwe Waterweg, Noord, Oosterschelde, Oude IJssel, Oude Maas, Oude Rijn, Pannerdens Kanaal, Regge, Rhine, Rotte, Rur, Scheldt, Scheur, Schie, Schipbeek, Spaarne, Spui, Steenbergse Vliet, Swalm, Vecht (Overijssel), Vecht (Utrecht), Vliet, Voer, Volkerak, Waal, Western Scheldt, Wurm, Zaan, Zwarte Water
List of rivers of New Zealand
This is a list of rivers in New Zealand. In a small number of cases, there are multiple rivers with the same name; in these cases the notation "(#)" shows the number of rivers sharing the same name.
List of rivers of Nicaragua
Most of the rivers in Nicaragua are on the Caribbean coast and empty out into the Caribbean Sea. The Río San Juan is one of the most important rivers in Nicaragua. It borders Costa Rica and connects the Caribbean Sea to Lake Cocibolca which flows out to the Pacific Ocean.
This list is arranged by where the river drains. Tributaries are indented under each larger stream's name.
Christopher Showerman
Christopher Frederick Showerman (born June 24, 1971) is an American actor and comedian. He is best known for playing George in "George of the Jungle 2", taking over from Brendan Fraser.
List of rivers of Nigeria
This is a list of rivers in Nigeria
Benue River – Bonny River
Calabar River – Chanomi Creek – Cross River
Donga River
Ekulu River – Escravos River
Forcados River
Gadar Tamburawa River – Gongola River – Goulbi de Maradi River – Great Kwa River
Hadejia River
Imo River
Jama'are River
Ka River – Kaduna River – Katsina Ala River – Kwa Ibo River