Pseudocroup

Synonyms in a broader sense

Medical:

• Acute Laryngitis
• Acute laryngitis

Definition

Pseudocroup is an inflammation of the larynx with laryngitis, which usually occurs as an additional infection in nasal inflammation, sinusitis and pharyngitis. Infants are particularly frequently affected, in which the viral infection causes swelling in the area of the laryngeal tissue and typical signs (symptoms) of “barking” cough, hoarseness and shortness of breath

Pseudocrupp attack

In connection with the clinical picture of laryngitis subglottica, the pseudocroup, there is often talk of the so-called pseudocroup attack. Depending on the author and the pediatrician’s specific choice of words, the term is used to describe either the overall event – or “merely” a particularly severe respiratory distress attack. The symptomatic overall picture of the pseudocroup includes a very characteristic cough, severe hoarseness, which can sometimes even make speaking impossible, and shortness of breath.

All symptoms set in very suddenly and especially at night. But also a spastic pseudocroup, which can trigger seizures due to a hyper-reaction to certain allergens (e.g. cat hairs, house dust mites), will lead to sudden episodes of severe breathing difficulties in the affected children. Pseudocroup attacks usually occur at night because during this period the body’s own cortisone production reaches its minimum, i.e. there is a worse reaction to inflammatory stimuli; the inflammation that ultimately triggers the attack can “break through” because the natural immune defence is weaker.

Causes

What triggers a pseudocroup? recurrent infections in the nasopharyngeal area (pharyngitis, rhinitis, sinusitis, tonsillitis, and tonsillitis) promote inflammation of the nearby larynx. It is usually a viral infection of the mucous membrane under the epiglottis (=subglottic space). The viruses originate from the group of cold viruses (adeno-, rhinoviruses). In some cases there is an additional bacterial infection (superinfection) with a haemophilus influenza germ (HiB).

Symptoms

Barking cough, breathlessness especially when inhaling (inspiratory stridor), light fever and the hoarseness of the children mark the pseudo croup. The shortness of breath causes visible retractions of skin and muscles on the chest and above the breastbone. The shortness of breath can be so stressful for small children that they become increasingly exhausted and an acute lack of oxygen sets in.

Typical is the onset of symptoms after the child has been taken to bed. The children then suffer from loud, barking coughs and shortness of breath. Parents must react immediately if the child no longer reacts to them, shows paleness or blue discoloration or is even unconscious.

During the day the symptoms usually subside and reappear the following night. Coughing is a symptom of pseudocroup besides hoarseness, fever, possibly also rhinitis and fatigue. Due to the usually dry inflammation of the larynx, the cough gets its typical characteristics: it is described as a barking, dry or even rough cough.

If the cough appears unexpectedly from sleep in the form of a seizure lasting several minutes, this seizure can increase to the point of respiratory distress. Due to the particular hormone constellation at night time (especially little cortisol), the mucous membrane above the vocal folds swells more in the case of a laryngitis than during the day, as the inflammation cannot be sufficiently combated. The glottis becomes narrower and can impede the natural breathing rhythm.

In this case a pseudocroup attack occurs. Due to the irritation of the mucous membranes in the larynx and the resulting narrow gap, the air is forced through the glottis with great force and effort during exhalation. This explains at least in part the development of the coughing sound.

Inhaling, on the other hand, produces a rather whistling sound, which is called stridor. This noise can also be attributed to the narrowing of the glottis. Usually the pseudocroup and thus also the cough will have subsided after about 1-3 days.

In order to reduce the cough to a minimum during this time, it is advisable to pay attention to a few circumstances: The apartment, but especially the bedroom should be regularly ventilated, especially before going to bed, so that cool fresh air is in the room and dry air from the heating system can escape. Furthermore, the patient can inhale essential oils or chamomile to soothe the respiratory tract, place a humidifier in the room or just a bowl of water on the heater and drink a lot.Since most pseudocroup attacks are caused by a viral infection that inflames the mucous membrane in the mouth and throat area and causes it to swell, fever is not uncommon in affected children. Smaller children in particular often react to a wide variety of pathogens at a relatively early stage by raising their temperature.

Fever can therefore occur as an accompanying symptom of the previous illness, but does not necessarily have to be conspicuous in a pseudocroup. Caution is required in the case of very high fever: Pediatricians, but of course also affected parents, should then also think of the so-called supraglottic laryngitis, epiglottitis, which has become very rare in the meantime due to an almost universal vaccination against its pathogen (Haemophilus influenzae), but potentially poses a life-threatening danger. This requires the immediate intervention of an experienced pediatrician.