Chapter 28.1, Problem 1QC

Summary Introduction

To compare and contrast: Pathology, clinical presentation, and the severity of croup and epiglottitis.

Concept introduction: Croup illnesses are diseases of the pulmonary system that are characterized by infection and obstruction of upper airways. Epiglottitis is an infection of the upper airways caused by Haemophilius influenza type B (HiB).

Explanation of Solution

Tabular representation: Table 1 compares and contrasts the pathology, clinical presentations, and the severity of croup and epiglottitis.

Table 1: Pathology, clinical presentations, and severity of croup and epiglottis of the upper airways

	Croup	Epiglottitis
Pathology	Subglottic inflammation. Edema. Increased resistance to airflow. Increased effort to breathe. Negative intrathoracic pressure. May cause dynamic collapse of the upper airway.	Inflammation of the epiglottis. Edema of the epiglottis.
Clinical presentation	Rhinorrhea. Sore throat. Low-grade fever. Barking cough. Inspiratory stridor. Hoarse voice. Agitation. Pallor. Cyanosis. Spasmodic croup’s cough that usually occurs in the night.	High fever. Irritability. Sore throat. Inspiratory stridor. Severe respiratory distress. Muffled voice. Drooling. Absence of cough. Dysphagia. Preference to sit. Child often wants to tripod to improve breathing. Death in few hours. Pneumonia. Cervical lymph node inflammation. Otitis.
Severity	Requires only outpatient treatment. Administration of glucocorticoids either by injection, oral or nebulization. Moderate to severe retractions of the chest require inpatient observation and treatment. Administration of oxygen or heliox (rare cases). In severe cases, endotracheal tube replacement may be required.	Life-threatening emergency. Child should be kept calm. Examination of throat to be prevented as it may cause laryngospasm and respiratory collapse. Severe airway obstruction. Intubation required. Administration of antibiotics, recemic epinephrine, and corticosteroids intravenously.