Pseudocroup, infectious croup or laryngitis subglottica is a laryngitis that is more common in young children, rather than adults. The cause of this disease is a viral infection of the respiratory tract, which results in constriction, so that the affected person sometimes suffers from shortness of breath and barking cough. Treatment by a physician is advised.
What is pseudocroup?
Pseudocroup is an inflammation that can be localized below the glottis and in the area of the larynx. Pseudocroup represents a disease of the upper respiratory tract and is manifested by hoarseness and a barking cough. In extreme situations, it can also lead to respiratory distress. The disease very often affects children and infants from six months to six years. Adults and older children are more rarely affected. Younger children are therefore more likely to contract pseudocroup because, unlike older children, their larynx is still relatively narrow. True croup is far more dangerous than pseudocroup.
Causes
While true croup is identical to laryngeal diphtheria, pseudocroup is caused by parainfluenza viruses or, very rarely, measles, rhino, or RS viruses. Accordingly, pseudocroup is a viral infection, as a result of which the mucous membrane of the larynx located below the vocal cords becomes inflamed. The resulting swelling and thick mucus constrict the airways, making it harder for the patient to breathe. Due to the fact that in young children the larynx is often still constricted and therefore a swelling has stronger effects, mainly infants and toddlers fall ill with pseudocroup. In addition, the weather also plays a certain role in the outbreak of the disease pseudocroup. Thus, most cases of pseudocroup occur in autumn or winter and especially in cold and humid weather and when the upper layers of air are warmer than the lower ones. If this is the case, one speaks of a so-called inversion weather situation, which favors the pseudocroup. Furthermore, scientists suspect that there is some connection between the emission of pollutants from industrial plants and the occurrence of pseudocroup.
Symptoms, complaints, and signs
The typical symptom of pseudocroup is a dry barking cough that occurs in attacks in the evening or at night. The voice may become hoarse and shortness of breath develops due to obstruction of the airways. Whistling or squeaking sounds are heard when breathing in. Since the disease usually develops as a result of a cold, its typical symptoms, such as a cold or fever, may also appear. In addition, there is a general feeling of illness, the patient feels tired and weak. If the shortness of breath increases, the lips and fingertips may turn blue due to the lack of oxygen. An acceleration of the heartbeat (tachycardia) is also possible. Because these symptoms are frightening, the patient becomes agitated, which in turn can exacerbate the present symptoms. In adults, the symptoms are usually much weaker than in children. The symptoms indicate which stage the disease has reached. If only hoarseness and coughing are present, stage 1 exists. Stage 2 is characterized by soft breathing sounds when inhaling, stage 3 by shortness of breath, tachycardia, anxiety and facial pallor. Stage 4 of the disease is present when the shortness of breath becomes more severe, the pulse is felt only very shallowly, the breath sounds are present on both inhalation and exhalation, the skin turns blue, and consciousness is clouded.
Course of disease
In pseudocroup, patients are plagued by a barking cough characteristic of this disease. Furthermore, hoarseness associated with a whistling sound that occurs during inspiration is characteristic of pseudocroup. If the larynx is severely constricted as a result of the swelling and inflammation, pseudocroup may also cause severe respiratory distress, which is very often manifested by very labored breathing and retraction of the jugular fossa and intercostal spaces. If the oxygen supply is so disturbed as a result of the shortness of breath in pseudocroup, the fingernails and lips may turn blue and, in rare cases, the heart may race. A sudden appearance at night, is typical for pseudocroup.
Complications
Most cases of pseudocroup heal without developing complications.In a severe course, however, it is possible that the airways become extremely narrowed. Breathing then becomes so strenuous for the affected person that he or she draws in the intercostal spaces and the jugular pit in the process. If the obstruction of the airways finally leads to an insufficient supply of oxygen to the body and brain, the patient first experiences palpitations, followed by a bluish discoloration of the lips and fingernails. The shortness of breath usually causes great anxiety to those affected, who are usually small children. The resulting panic further aggravates the original symptoms. Under these circumstances, the disease can become life-threatening and, in rare cases, fatal. This is especially true if the disease breaks out at night without warning. Then there is a risk that the children will not receive medical treatment in time. In rare cases, a pseudocroup infection can also spread to the middle ear, trachea or lungs. Then there is a threat of acute middle ear infection, tracheitis (inflammation of the windpipe) or pneumonia (inflammation of the lungs). These diseases can usually all be treated very well. However, further complications due to these sequelae are still possible.
When should you go to the doctor?
If the typical whistling sound occurs when breathing in, often associated with hoarseness and sore throat, pseudocroup may be present. Prior to this, signs of a cold with fever and chills may occur in association with the illness. If the symptoms do not disappear quickly, the doctor must be consulted. Medical advice is required at the latest when the lips and facial skin turn bluish. Very high fever indicates another illness that should be clarified by a doctor. Pseudocroup occurs mainly after a viral infection with measles or influenza viruses. Babies and young children as well as adults with chronic respiratory diseases are particularly affected. The patients at risk should see a doctor quickly with symptoms mentioned above. If the symptoms occur in connection with cold air, cigarette smoke or environmental toxins, pseudocroup may also be the underlying cause. Affected persons are best advised to contact their family doctor or an ENT specialist. Depending on the severity of the condition, other respiratory specialists may need to be involved in treatment.
Treatment and therapy
If the shortness of breath is particularly threatening in pseudocroup, nebulization with epinephrine can very quickly reduce the swelling of the mucous membrane and thus relieve the symptoms of pseudocroup. Furthermore, cortisone preparations, for example prednisone, are very often prescribed for pseudocroup. These are administered either as suppositories into the anus or, much less frequently, via venous access. If the pseudocroup patient is in an extremely poor condition, he or she must be transferred to a hospital where, as a rule, so-called endotracheal intubation is performed under general anesthesia in the case of pseudocroup. In this procedure, a hollow probe, usually made of plastic, is inserted either through the nose or the mouth into the trachea through the vocal folds located on the larynx. The airways are sealed with the help of a balloon, which prevents secretions from entering. As a result, external ventilation of the pseudocroup patient is now possible.
Follow-up
In most cases, pseudocroup progresses with mild symptoms and heals completely within three to five days. More severe manifestations often require hospitalization. In these cases, physicians administer adrenaline for inhalation and high doses of glucocorticoids, and oxygen is given in case of respiratory insufficiency. Outpatient follow-up includes regular routine checks to assess general condition and initiate appropriate therapy if symptoms increase. Parents should always report to the follow-up physician if swallowing difficulties occur, fever persists for more than three days, or signs of respiratory distress reappear. For relatives, there are also self-help groups and parents’ initiatives on the subject of croup syndrome. Many useful tips make it easier to deal with the respiratory infection. Here, too, the doctor can name the right people to contact. In the context of aftercare, counseling centers offer the opportunity to exchange information about pseudocroup, receive suggestions for therapeutic measures, and benefit from the experiences of other parents.Since a pseudocroup attack can recur in children, treatment recommendations by doctors and specialists are particularly important. This applies, for example, to the correct way to deal with a recurrence of a pseudocroup attack. Insured persons can also obtain competent information on viral croup from the telephone service center of their health insurance company. Experts such as medical specialists, registered nurses and nutrition coaches of the medical hotlines provide concrete information and valuable guidance on all questions related to the clinical picture of pseudocroup on 365 days.
Here’s what you can do yourself
A pseudocroup attack stresses parents and child. As a parent, it is important to stay calm and keep your own nervousness away from the coughing child: Hectic and stress can possibly trigger a panic attack, further aggravating the shortness of breath. During an acute attack, parents should therefore have a calming effect on the child and try to distract him or her as much as possible by keeping the child occupied. In the event of severe pain or clouding of consciousness, a doctor must be consulted immediately. As a home remedy, cool, moist throat compresses have proven effective in preventing further swelling of the mucous membranes around the larynx. Alternatively, ice cubes wrapped in a cloth can be used. Drinking tea or still mineral water in small sips can also relieve irritation: However, parents must be careful that the child does not choke when doing so. As a preventive measure, it is advisable to keep the air in the room as cool and humid as possible. Especially in the evening, damp cloths can be hung up in the child’s room or humidifiers can be attached to the heating system. In addition, children suffering from pseudocroup should spend as much time outdoors as possible; salty air by the sea often brings long-term relief. In addition, a balanced diet rich in vitamins helps to strengthen the immune system.
