Insidious false croup. False croup in children How contagious is false croup

An acute inflammatory process of the larynx, accompanied by swelling of its subglottic region, which leads to stenosis of the larynx and obstruction of the upper respiratory tract. False croup is manifested by a dry "barking" cough, a hoarse voice and inspiratory dyspnea, causing noisy breathing. The severity of the condition of patients with false croup depends on the degree of stenosis of the larynx and often changes during the day. False croup is diagnosed due to the characteristic clinic and auscultatory picture in the lungs, as well as the data of the CBS blood test, blood gas analysis, laryngoscopy, radiography, bakposev, PCR and ELISA diagnostics. Treatment of patients with false croup is carried out with antibiotics, antitussives, sedatives, antihistamines and glucocorticoid drugs.

General information

Stenosing laryngitis, which develops with diphtheria, is called true croup. Cases of stenosing laryngitis of other infectious etiology are included in the concept of false croup. In otolaryngology, false croup has several synonymous names: stenosing laryngitis, acute obstructive laryngitis, subglottic laryngitis, subglottic laryngitis. False croup occurs mainly in young children. This is due to the funnel-shaped shape and small size of their larynx, looser tissue of the subglottic region. Such anatomical features of the children's larynx contribute to the rapid development of inflammation and edema. In adults, mainly diphtheria (true) croup is noted. Approximately half of the cases of false croup occur in children 1-3 years old. Children over 6 years of age rarely get sick with false croup, they make up only 9% of the total number of cases. The seasonality of the incidence of false croup is pronounced, its peak occurs at the end of autumn and the beginning of winter.

Causes and pathogenesis of false croup

The most common cause of false croup is a viral infection. These are predominantly parainfluenza, influenza and adenoviruses, less often the measles virus, herpes simplex, chickenpox, whooping cough. False croup of bacterial etiology (Hemophilus influenzae, streptococci, staphylococci, pneumococci) is quite rare and is characterized by a more severe course. As a rule, false croup occurs as a complication of acute rhinitis, pharyngitis, adenoiditis, SARS, measles, chicken pox, scarlet fever and other infections. False croup may be the result of an exacerbation of chronic tonsillitis. The weakened state of the child's body as a result of birth trauma, fetal hypoxia, rickets, diathesis, artificial feeding, beriberi, reduced immunity contributes to the appearance of the disease.

III degree of stenosis. There is a strong inspiratory dyspnea with retraction during breathing of the jugular fossa, intercostal space and epigastric region. A patient with false croup has a pronounced "barking" cough, dysphonia and paradoxical breathing appear. Mixed dyspnea is possible, which is an unfavorable sign in terms of prognosis of the disease. Cyanosis is diffuse. The pulse is filiform with drops on inspiration, tachycardia. The anxiety of the child is replaced by lethargy, drowsiness, confusion occurs. In the lungs on inhalation and exhalation, dry and moist rales of various sizes are heard, muffled heart tones are noted.

IV degree of stenosis characterized by the absence of the “barking” cough and noisy breathing typical of false croup. Arrhythmic shallow breathing, arterial hypotension, bradycardia are observed. Seizures are possible. The consciousness of a patient with a false croup is confused and passes into a hypoxic coma. False croup with IV degree of stenosis can be fatal due to the development of asphyxia.

A distinctive feature is that false croup proceeds with changes in the severity of obstructive syndrome and inspiratory dyspnea throughout the day from pronounced to almost imperceptible. However, the greatest severity of the condition is always noted at night. It is at night that attacks of false croup occur, caused by severe stenosis of the larynx. They are manifested by a progressive feeling of suffocation, fear and restlessness on the part of the child, severe shortness of breath, characteristic cough, perioral cyanosis and pallor of the rest of the skin.

Complications of false croup

Violation of normal breathing in false croup with II-III degree stenosis leads to the attachment of bacterial flora and the formation of purulent-fibrinous films on the walls of the larynx. The spread of infection down the respiratory tract causes the development of acute tracheobronchitis, obstructive bronchitis and pneumonia. Sinusitis, otitis media, tonsillitis, conjunctivitis, purulent meningitis can also become a complication of croup.

Diagnosis of false croup

False croup is diagnosed by a pediatrician or an otolaryngologist based on a typical clinical picture, anamnesis data (the onset of a disease against a respiratory tract infection), the results of an examination of the child and auscultation of the lungs. Additionally, microlaryngoscopy and culture of a throat swab are performed to identify and identify the causative agent of a bacterial nature. The establishment of chlamydial and mycoplasmal flora, which in some cases causes false croup, is carried out by PCR and ELISA methods. To detect a fungal infection, a smear microscopy and inoculation on Sabouraud's medium are performed. The assessment of the severity of hypoxia, which is accompanied by false croup, is carried out by analyzing the CBS (acid-base state) and the gas composition of the blood. Diagnosis of complications due to false croup includes chest radiography, pharyngoscopy, rhinoscopy, otoscopy, and sinus radiography.

Differential diagnosis of false croup

False croup must first be differentiated from the true one. Diphtheria croup is characterized by a gradual and progressive increase in stenosis of the larynx, accompanied by dysphonia up to the complete absence of voice. False croup may occur with voice disturbances, but it never has aphonia. True croup is characterized by the lack of amplification of the voice when crying or screaming. In patients with false croup, voice amplification persists. The diagnosis of diphtheria croup is helped by the identification of diphtheria raids when examining the larynx and the detection of the causative agent of diphtheria during bacteriological examination of smears.

False croup is also differentiated from other diseases that may be accompanied by stenosis of the larynx. This is an allergic edema of the larynx, a foreign body of the larynx inhalation. False croup, accompanied by an unproductive cough, is an indication for the appointment of antitussive drugs (codeine, licorice root, thermopsis, oxeladin, prenoxdiazine).

Apply antihistamines (mebhydrolin, diphenhydramine, hifenadine), which have antitussive and decongestant effects. False croup with severe stenosis of the larynx is treated with glucocorticoid drugs, sedatives and antispastic drugs. Antibiotics are recommended from the first day of the disease with bacterial false croup or with the development of infectious complications. Therapy of a false croup of a viral nature is carried out with antiviral drugs.

The seizures that accompany false croup are due to reflex spasm of the larynx and can be stopped by attempts to induce an alternative reflex. To do this, press on the root of the tongue, provoking a gag reflex, or tickle in the nose, causing a reflex sneeze. Also used are hot foot baths, warm compresses on the larynx and chest, cans on the back.

Prognosis for false croup

A timely diagnosed false croup has a favorable prognosis and, against the background of adequate therapy, usually ends in a complete recovery. False croup, the treatment of which was started in the stage of decompensation, can be accompanied by severe complications and go to the terminal stage, often ending in death.

Any disease of children plunges parents into shock. Especially if the pathology is severe and there is no way to alleviate the symptoms. How to behave in such cases? Consider what is characteristic of croup in children and what treatment of pathology can be done at home.

What is a croup?

Croup is an acute inflammatory process that occurs in the respiratory tract. The larynx and trachea are most often affected, and the bronchi are much less common. As a rule, children suffer from croup.

This condition is provoked by infectious diseases. Since the cause is a viral "capture", people around can catch the infection.

It should be borne in mind that infection does not occur as a result of an acute inflammatory process, but a disease that provoked a similar condition. But the croup itself is not contagious, as it is a complication of the pathology. Therefore, a person who has contracted a major disease from a baby does not always develop an acute process.

Causes of croup:

diphtheria;
parainfluenza;
measles;
typhoid fever;
chickenpox;
tuberculosis;
flu;
scarlet fever;
adenovirus
syphilis;
banal ORZ.

Depending on the cause, the process is divided into 2 groups:

True croup in children. Such a diagnosis can only be made with diphtheria. The process is characterized by damage to the mucous membranes of the vocal cords;
False croup in children. In this case, the process affects the mucous membranes of the trachea below the vocal cords. All other infectious diseases of the respiratory tract in children lead to false croup.

The difference in causes leads to some difference in symptoms. Therefore, it is desirable to know what symptoms in children indicate the development of true or false croup.

Croup in children: symptoms and clinical picture

Despite the difference in causes, characteristic symptoms can be traced in both true and false processes:

At first, children develop a dry, barking cough. You may notice that during the crying of the baby, the cough increases significantly. If competent treatment of children is not started at this time, there is a possibility that the process will take a severe course;
In this case, stridor is observed - bubbling, wheezing, shortness of breath caused by swelling of the larynx. As the stenosis increases, the noises in the breath of children increase;
In the presence of dry cough and stridor, hoarseness of the voice is manifested. If the above two symptoms are absent, but the voice is hoarse, most likely, the small patient does not have croup, but laryngitis;
As with any disease of the upper respiratory tract, children have fever, soreness in muscle tissue, lethargy and moodiness.

With diphtheria, the condition of children worsens to severe. At the same time, a pronounced dense coating of white color appears on the tonsils. There is an unpleasant smell from the mouth. During the day, the symptoms may increase gradually, at night there is usually a sharp deterioration until a tragic outcome.

Most often, the diagnosis of "croup" is made to children in the age period from 6 months to 6 years. This is due to the structural nuances of the respiratory tract. The larynx and trachea have a rather narrow lumen, under the mucous membrane there is a decent layer of connective tissue with a rather loose consistency. As a result, the edema spreads rapidly, and the increased sensitivity of nerve receptors in this area contributes to the appearance of muscle spasm.

Croup should be distinguished from allergic laryngeal edema or laryngospasm due to rickets, which can occur in children under 2 years of age. In this case, there are no cold symptoms characteristic of an acute infectious and inflammatory process.

The first symptoms of an acute inflammatory process usually appear at night, when the drainage of the lungs decreases and the tone of the parasympathetic nervous system increases.

A natural question: is it possible for children in case of croup to be treated at home and what are the ways to reduce severe symptoms?

Croup in children: treatment

For any reason for the appearance of an acute inflammatory process, it is necessary first of all to call an ambulance.

Such a course of the disease is extremely dangerous, so there can be no talk of treatment with any folk remedies. The only thing that parents can do to alleviate the condition of their baby before the arrival of the medical team is to create "tropical atmosphere". For this small patient, it is advisable to place in a warm room with high humidity.

The best option is a bathroom filled with steam of hot water.

Among the necessary measures:

Give an antipyretic if the temperature exceeds 38.5 C. To do this, you can use Paracetamol or Ibuprofen. It is advisable to try to reduce laryngospasm with Baralgin or Maxigan;
Drink plenty of warm water, decoctions and compotes to help relieve swelling and relieve coughing. In addition, pathology can lead to dehydration, so drinking plenty of water is necessary;
You can use inhalation with saline solution using a nebulizer. If inhalation is not possible, bring the child into the bathroom more often so that he breathes warm vapor.

Further treatment, most likely, will take place in a hospital, since an acute inflammatory process requires constant medical supervision.

In babies, false croup occurs quite often, so mothers need to know about it. Only parents can notice the first signs of narrowing of the larynx in time and help the child in time.

False croup is a condition in which it becomes difficult for a child to breathe due to narrowing of the airways. The reason is viral infections. In children under 5-6 years of age, the airways are narrower than in adults, and therefore croup develops much more often.
If a baby with a cold has a "barking" cough and a hoarse voice, it is necessary that he breathe steam over hot water in the bathroom. If this does not help, and the breath becomes noisy and difficult, call an ambulance without stopping the inhalation of steam.

What is false croup?

Croup is difficulty in breathing due to constriction of the larynx. To feel where the larynx is, you can put your hand on the front of the neck and make any sound - the larynx will vibrate.

This part of the airway is quite narrow, and if the mucous membrane swells, it can completely block the lumen of the larynx, and air will not enter the lungs. In children under 5-6 years of age, the airways are narrower than in adults, and therefore croup develops much more often.

Unlike false, true croup begins with diphtheria, when the lumen of the larynx is blocked by dense films. Thanks to vaccinations (DPT, ADS-M), this disease, fortunately, has become rare.

The cause of false croup is acute viral infections (for example, parainfluenza virus or respiratory syncytial virus). The mucous membrane becomes inflamed, swells, and although films do not form, as in diphtheria, the result is the same - it is difficult for the child to breathe.

How does it all start?

Usually, the usual symptoms of acute respiratory infections first appear, that is, a runny nose, cough, and fever. The first signs of the proximity of a false croup arise or intensify in the evening - this is a growing dry "barking" cough and a hoarse voice.

Then the breath becomes "noisy" - at first only during crying or anxiety, that is, when the baby breathes deeper and faster. After a while, these symptoms persist even in a calm state.

With croup, it is difficult for a baby to inhale, that is, the inhalation turns out to be noisy, with effort, and the exhalation remains normal. During inhalation, you can notice how the jugular fossa (depression in the lower part of the neck between the collarbones) is drawn inward.

Can false croup be prevented?

There are pathogens that most often cause croup: parainfluenza virus, influenza virus, and respiratory syncytial virus. If a child has contracted this particular infection, the risk of developing croup is high, and, unfortunately, there are no remedies that protect against it.

There are children who tolerate colds without this complication, but in some the mucous membrane is more prone to edema, and if one episode of difficulty in breathing with ARI has already been, it is likely that such conditions will recur. Parents need to be ready for them - until the child grows up, and the croup ceases to threaten him.

What to do with false croup?

If you notice its signs, first of all, you need to calm yourself and the child, because when you are excited, the muscles of the larynx contract, and it becomes even harder to breathe.

With a "barking" cough, as long as breathing is silent and not difficult, steam inhalation can help. Turn on hot water in the bathroom, let the child breathe in moist air for a few minutes.

If this does not help, and it becomes difficult to breathe (noisy breath, retraction of the jugular fossa), call an ambulance and continue to do steam inhalation until it arrives. The doctor will prescribe special inhalations with a local hormonal preparation for croup. Don't let the word "hormonal" scare you, because this drug works only in the respiratory tract, eliminating inflammation, and no other medicine for false croup will not be so effective. In severe cases, the doctor will inject a hormone (prednisolone or dexamethasone) intramuscularly. Don't worry about side effects because short cycles of hormones are safe and life-saving in these situations.

If you are offered to hospitalize your child, do not refuse, because after temporary relief, breathing problems may recur.

There are conditions that can be confused with false croup, such as inflammation of the epiglottis (cartilage that closes the larynx when swallowing). This disease is called epiglottitis: the child's temperature rises above 39 degrees, there is a severe sore throat, the mouth is difficult to open, and hormonal preparations do not help the child.

With inflammation of the epiglottis, the child is admitted to the hospital and treated with antibiotics. But this disease is rare, and false croup is caused by viruses, so it makes no sense to take antibiotics.

Is it possible to interrupt an attack of croup on your own?

If false croup in a child does not occur for the first time, you can take home a special device for inhalation - a nebulizer (choose a compressor model, since ultrasound can destroy drugs used for croup). Your doctor will tell you what medication to have at home and how much to use if needed.

The child can return to kindergarten as soon as the body temperature returns to normal and the baby feels good.

Acute respiratory pathologies can lead to dangerous complications and disruption of the respiratory system. Croup is one of the common consequences of infectious diseases. It affects mainly babies aged 3 months to 3 years.

What is false croup in children?

An alternative name for the disease in question is stenosing laryngitis. It is an acute inflammation of the larynx, in which there is a sharp and sudden narrowing of its walls and obstruction of the upper respiratory tract. This can cause choking, especially if the child is small. It differs from false by the causative agent of the pathological process. In the first case, diphtheria is the cause of the problem, and in the second, other infectious agents.

The mechanism of development of stenosing laryngitis

False croup in children is due to the following processes:

Severe inflammation of the larynx leads to severe swelling or swelling of the soft tissues in the space under the vocal cords.
Acute stenosing laryngitis provokes spasms of the constrictor muscles. They contract, so the lumen of the larynx sharply narrows.
Inflammatory processes are accompanied by the release of a large amount of viscous sputum. Mucus accumulates in the narrow lumen of the larynx and can completely block it.

False croup in children - causes

The causative agent of the described disease are infections. In most cases, viruses cause false croup in children - the causes of its development include such pathologies:

simple herpes;
measles;
adenovirus;
chicken pox;
whooping cough.

Less commonly diagnosed is stenosing laryngitis of bacterial origin. In this situation, the reasons are:

streptococci;
hemophilic bacillus;
pneumococci;
staphylococci.

False croup in children can begin against the background of tonsillitis, rhinitis, adenoiditis and other diseases as a complication. The following factors contribute to its development:

rickets;
avitaminosis;
birth trauma;
transferred hypoxia;
diathesis;
artificial feeding;
low immunity.

The main reason for the occurrence of false croup exclusively in children and the absence of this condition in adults is the size of the larynx. In a child, it is initially small, so even a slight narrowing of its lumen leads to asthma attacks. As they grow older, the larynx increases, and the child simply "outgrows" stenosing laryngitis.

The pathology itself is not transmitted from one child to another, even with close direct contact, but it is better to immediately isolate a sick baby. Stenosing laryngitis in children always progresses against the background of an acute respiratory infection. Viral or bacterial diseases are very contagious, so several cases of inflammation and narrowing of the lumen of the larynx at the same time are often found in the team.

How to identify false croup in a child?

The presented condition has specific features that allow it to be accurately diagnosed. False croup in children - symptoms:

loud "barking" cough;
noisy breathing, sniffling;
hoarseness of voice;
anxiety;
dyspnea;
swollen lymph nodes in the neck area;
an increase in body temperature (from 37.2 degrees, depending on the cause of the disease);
sleep disorders.

Degrees of false croup in children

The clinical picture of stenosing laryngitis corresponds to the severity of its course. How false croup manifests itself in children with different degrees of narrowing of the lumen of the larynx:

Compensated. Shortness of breath and shortness of breath are observed only against the background of physical or emotional stress. When inhaling, wheezing may be heard.
Subcompensated. Symptoms of false croup are present in children and at rest. The child is excited, eats and sleeps badly. On inspiration, retraction of the intercostal spaces and the jugular fossa occurs, dry rales are heard. The nasolabial triangle acquires a light cyanotic color.
Decompensated. The baby's anxiety is replaced by drowsiness, lethargy and apathy, confusion. The child is tormented by severe shortness of breath and a "barking" cough, his voice disappears. The whole face and part of the neck has a bluish tint. On inspiration, dry and wet rales are clearly audible, the heart is unstable (tachycardia), the pulse is filiform.
Asphyxia. The heaviest version of the false croup. The child's breathing is superficial and arrhythmic, there is no cough. There is a sharp decrease in blood pressure, bradycardia, convulsions. Consciousness is confused and goes into a hypoxic coma. Without emergency care, this condition can be fatal.

If parents notice obvious signs of stenosing laryngitis in a baby with difficulty breathing and a blue nasolabial triangle, medical attention should be sought immediately. False croup is especially dangerous in infants, because the size of their larynx is very small and asphyxia can occur quickly. Before the arrival of a team of specialists, it is important to calm the child as much as possible and provide him with comfortable conditions for normal breathing.

When an attack of false croup in a child is not accompanied by shortness of breath or suffocation, but only a “barking cough” is present, you can deal with the problem yourself:

Give a plentiful alkaline drink (bicarbonate water without gas, low-fat milk with a pinch of soda).
Ensure voice rest.
At high temperatures (more than 38 degrees), use an antipyretic drug.
Make an inhalation with a nebulizer with mineral water or saline.
Cool the air in the room to 18 degrees or below.

Stenosing laryngitis in children - emergency care

Before the arrival of qualified doctors, it is important to prevent further narrowing of the lumen of the larynx and asphyxia. First aid for false croup in a child, described in the previous section, and additional measures will be effective:

Induce a gag reflex by pressing a finger or spoon on the root of the tongue.
Humidify the air in the room. If there is no special apparatus, you can hang cool wet towels in the room, move the baby to the bathroom, where cold water flows from the taps.
Make inhalations. With the ineffectiveness of the previously proposed drugs, Pulmicort is used for false croup in children.
Position the child half-sitting in bed so that less mucus accumulates in the larynx.

False croup in children - treatment

Therapy for stenosing laryngitis is prescribed only by a doctor individually. Options for treating false croup in children depend on the frequency and severity of attacks, the age of the baby, and the causative agent of the infection. In the fight against this disease, the following groups of medicines are used:

glucocorticosteroid hormones (Prednisolone, Methylprednisolone);
antispasmodics (Papaverine, No-Shpa);
antitussives (Codeine, Bromhexine);
antihistamines (Eden, Zodak);
bronchodilators (Lazolvan, Geksoral);
sedatives (extract of valerian, motherwort);
antiviral (Tamiflu, Remantadin);
antibiotics (Erythromycin, Amoxicillin) and others.

In addition, inhalations are prescribed for false croup in a child. Humidified oxygen is used in the hospital clinic, it is advisable to purchase a good nebulizer at home, especially if the baby is often exposed to stenosing laryngitis. Procedures are performed using any hypoallergenic alkaline solutions, Lazolvan, Pulmicort.

How to avoid false croup in children?

The only way to prevent pathology is to prevent its causes - SARS and acute respiratory infections. False croup in children always begins against the background of infections, so parents need to strengthen the baby's immune system, monitor the temperature and humidity in his bedroom. The answer to the question of how to prevent false croup in a child after infection with the flu or another disease is similar. The baby should be in a cool and humid room, inhalations with a nebulizer are carried out 2-3 times a day, one of them should be before bedtime.