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65-462: Croup ( / k r uː p / KROOP ), also known as croupy cough , is a type of respiratory infection that is usually caused by a virus . The infection leads to swelling inside the trachea , which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough , inspiratory stridor and a hoarse voice . Fever and runny nose may also be present. These symptoms may be mild, moderate, or severe. Often it starts or

130-452: A bacteriophage carrying a gene which gives rise to a toxin . This toxin causes the disease. Diphtheria is caused by the adhesion and infiltration of the bacteria into the mucosal layers of the body, primarily affecting the respiratory tract and causing the subsequent release of an exotoxin. The toxin has a localized effect on skin lesions, as well as a metastatic, proteolytic effects on other organ systems in severe infections. Originally

195-480: A steeple in shape. The steeple sign is suggestive of the diagnosis, but is absent in half of cases. Other investigations (such as blood tests and viral culture ) are discouraged, as they may cause unnecessary agitation and thus worsen the stress on the compromised airway. While viral cultures, obtained via nasopharyngeal aspiration, can be used to confirm the exact cause, these are usually restricted to research settings. Bacterial infection should be considered if

260-621: A day and 80% of cases in two days. It can very rarely result in death from respiratory failure and/or cardiac arrest . Symptoms usually improve within two days, but may last for up to seven days. Other uncommon complications include bacterial tracheitis , pneumonia , and pulmonary edema . Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females, and there

325-720: A diphtherial disease, but with vaccination, diphtheria is now rare in the developed world. Most children with croup have mild symptoms and supportive care at home is effective. For children with moderate to severe croup, treatment with corticosteroids and nebulized epinephrine may be suggested. Steroids are given routinely, with epinephrine used in severe cases. Children with oxygen saturation less than 92% should receive oxygen, and those with severe croup may be hospitalized for observation. In very rare severe cases of croup that result in respiratory failure, emergency intubation and ventilation may be required. With treatment, less than 0.2% of children require endotracheal intubation . Since croup

390-568: A lower risk of side effects. Despite the superior filtration capability of N95 filtering facepiece respirators measured in vitro, insufficient clinical evidence has been published to determine whether standard surgical masks and N95 filtering facepiece respirators are equivalent to preventing respiratory infections in healthcare workers. Adults in intensive care units (ICU) have a higher risk of acquiring an RTI. A combination of topical and systematic antibiotics taken prophylactically can prevent infection and improve adults' overall mortality in

455-616: A major cause of childhood mortality, diphtheria has been almost entirely eradicated due to the vigorous administration of the diphtheria vaccination in the 1910s. Diphtheria is no longer transmitted as frequently due to the development of the vaccine, DTaP. Although diphtheria outbreaks continue to occur, this is often in developing countries where the majority of the population is not vaccinated. Four subspecies are recognized: C. d. mitis , C. d. intermedius , C. d. gravis , and C. d. belfanti . The four subspecies differ slightly in their colonial morphology and biochemical properties, such as

520-505: A month. The most common routes of entry for C. diphtheriae are the nose, tonsils, and throat. Individuals suffering from the disease may experience sore throat, weakness, fever, and swollen glands. This could cause even more dangerous symptoms such as shortness of breath. If left untreated, diphtheria toxin may enter the bloodstream, causing damage to the kidneys, nerves, and heart. Extremely rare complications include suffocation and partial paralysis. A vaccine, DTaP , effectively prevents

585-485: A person does not improve with standard treatment, at which point further investigations may be indicated. The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice. It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions. The points given for each factor

650-567: A set of advanced Pulmonary Function Testing will be based on abnormally high values in previous test results. A 2014 systematic review of clinical trials does not support routine rapid viral testing to decrease antibiotic use for children in emergency departments. It is unclear if rapid viral testing in the emergency department for children with acute febrile respiratory infections reduces the rates of antibiotic use, blood testing , or urine testing . The relative risk reduction of chest x-ray utilization in children screened with rapid viral testing

715-437: A toxigenic strain of Corynebacterium diphtheriae infects the human body, it releases harmful toxins, especially to the throat. Antitoxins are used to prevent further harm. Antibiotics are also used to fight the infection. Typical antibiotics that are used against diphtheria involve penicillin or erythromycin. People infected with diphtheria must quarantine for at least 48 hours after being prescribed antibiotics. To confirm that

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780-428: A very sick appearance can indicate other medical conditions, such as epiglottitis or tracheitis . Croup is usually deemed to be due to a viral infection. Others use the term more broadly, to include acute laryngotracheitis ( laryngitis and tracheitis together), spasmodic croup, laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. The first two conditions involve

845-459: A viral infection and are generally milder with respect to symptomatology; the last four are due to bacterial infection and are usually of greater severity. Viral croup or acute laryngotracheitis is most commonly caused by parainfluenza virus (a member of the paramyxovirus family), primarily types 1 and 2, in 75% of cases. Other viral causes include influenza A and B, measles , adenovirus and respiratory syncytial virus (RSV). Spasmodic croup

910-426: Is 77% compared with controls. In 2013 researchers developed a breath tester that can promptly diagnose lung infections. Bacteria are unicellular organisms present on Earth can thrive in various environments, including the human body. Antibiotics are a medicine designed to treat bacterial infections that need a more severe treatment course; antibiotic use is not recommended for common bacterial infections as

975-401: Is DIP0733, a multi-functional protein that has shown to have a role in bacterial adhesion to host cells and fibrogen-binding qualities. In experiments with mutant strains of the C. diphtheriae , adhesion and epithelial infiltration decreased significantly. The ability to bind to extracellular matrices aids the bacteria in avoiding detection by the body's immune system. The diphtheritic lesion

1040-578: Is an increased prevalence in autumn. The word croup comes from the Early Modern English verb croup , meaning "to cry hoarsely." The noun describing the disease originated in southeastern Scotland and became widespread after Edinburgh physician Francis Home published the 1765 treatise An Inquiry into the Nature, Cause, and Cure of the Croup . Diphtheritic croup has been known since

1105-557: Is between 40 and 60%. Therefore, relative humidity in this range can help lessen the risk of aerosol transmission. Respiratory infections often have strong seasonal patterns, with temperate climates more affected during the winter . Several factors explain winter peaks in respiratory infections, including environmental conditions and changes in human behaviors. Viruses that cause respiratory infections are affected by environmental conditions like relative humidity and temperature. Temperate climate winters have lower relative humidity, which

1170-447: Is caused by the same group of viruses as acute laryngotracheitis, but lacks the usual signs of infection (such as fever, sore throat, and increased white blood cell count ). Treatment, and response to treatment, are also similar. Croup caused by a bacterial infection is rare. Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. Laryngeal diphtheria

1235-421: Is colorimetrically indicated by brown colonies for most Cornyebacterium species or by a black halo around the C. diphtheriae colonies. The organism produces catalase but not urease , which differentiates it from Corynebacterium ulcerans . C. diphtheriae does not produce pyrazinamidase which differentiates from Corynebacterium striatum and Corynebacterium jeikeium . Corynebacterium diphtheriae

1300-639: Is commonly knowns as the DTaP or Tdap vaccine. DTaP vaccine is for children while the Tdap vaccine is known for adolescents and adults. In the United States, the DTaP vaccine to parents of infants which typically involves a series of five shots is recommended. These vaccines are injected through the arm or thigh and are administered when the infant is 2 months, 4 months, 6 months, 15–18 months and then 4–6 years old. Possible side events that are associated with

1365-463: Is due to Corynebacterium diphtheriae while bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterial growth. The most common cocci implicated are Staphylococcus aureus and Streptococcus pneumoniae , while the most common bacteria are Haemophilus influenzae , and Moraxella catarrhalis . The viral infection that causes croup leads to swelling of

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1430-430: Is encoded by the bacteriophage found in toxigenic strains, integrated into the bacterial chromosome. The diphtheria toxin repressor is mainly controlled by iron. It serves as the essential cofactor for the activation of target DNA binding. A low concentration of iron is required in the medium for toxin production. At high iron concentrations, iron molecules bind to an aporepressor on the beta bacteriophage, which carries

1495-738: Is high; 47 million prescriptions in the United States in 2018 were made for infections that do not need antibiotics to be treated with. It is recommended to avoid antibiotic use unless bacterial infections are severe, transmissible, or have a high risk of further complications if left untreated. Unnecessary use of antibiotics could increase antibiotic-resistant infections, affect the digestive system , create allergic reactions , and other intense side effects. A study published in JAMA found that narrow-spectrum antibiotics, such as amoxicillin, are just as effective as broad-spectrum alternatives for treating acute respiratory tract infections in children, but have

1560-449: Is important. Children with croup should generally be kept as calm as possible. Over the counter medications for pain and fever may be helpful to keep the child comfortable. There is some evidence that cool or warm mist may be helpful, however, the effectiveness of this approach is not clear. If the child is showing signs of distress while breathing ( inspiratory stridor , working hard to breathe, blue (or blue-ish) coloured lips, or decrease in

1625-483: Is known to increase the transmission of influenza . Of the viruses that cause respiratory infections in humans, most have seasonal variation in prevalence. Influenza, Human orthopneumovirus (RSV), and human coronaviruses are more prevalent in the winter. Human bocavirus and Human metapneumovirus occur year-round, rhinoviruses (which cause the common cold ) occur mostly in the spring and fall, and human parainfluenza viruses have variable peaks depending on

1690-506: Is listed in the adjacent table, and the final score ranges from 0 to 17. 85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%). Croup is contagious during the first few days of the infection. Basic hygiene including hand washing can prevent transmission. There are no vaccines that have been developed to prevent croup, however, many cases of croup have been prevented by immunization for influenza and diphtheria . At one time, croup referred to

1755-432: Is needed, "blow-by" administration (holding an oxygen source near the child's face) is recommended, as it causes less agitation than use of a mask . While other treatments for croup have been studied, none has sufficient evidence to support its use. There is tentative evidence that breathing heliox (a mixture of helium and oxygen ) to decrease the work of breathing is useful in those with severe disease, however, there

1820-479: Is often covered by a pseudomembrane composed of fibrin, bacterial cells, and inflammatory cells. Diphtheria toxin can be proteolytically cleaved into two fragments: an N-terminal fragment A (catalytic domain), and fragment B (transmembrane and receptor binding domain). Fragment A catalyzes the NAD+ -dependent ADP-ribosylation of elongation factor 2, thereby inhibiting protein synthesis in eukaryotic cells. Fragment B binds to

1885-404: Is often described as resembling the call of a sea lion . The stridor is worsened by agitation or crying , and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably. Other symptoms include fever , coryza (symptoms typical of the common cold ), and indrawing of the chest wall –known as Hoover's sign . Drooling or

1950-521: Is person-to-person contact via respiratory droplets (i.e., coughing or sneezing). Less commonly, it could also be passed by touching open sores or contaminated surfaces. During the typical course of disease, the body region most commonly affected is the upper respiratory system. A thick, gray coating accumulates in the nasopharyngeal region, making breathing and swallowing more difficult. The disease remains contagious for at least two weeks following disappearance of symptoms, but has been known to last for up to

2015-470: Is slightly more common in males than females. It occurs most often in autumn. Before vaccination , croup was frequently caused by diphtheria and was often fatal. This cause is now very rare in the Western world due to the success of the diphtheria vaccine . Croup is characterized by a "barking" cough , stridor , hoarseness , and difficult breathing which usually worsens at night. The "barking" cough

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2080-514: Is taken as the tract above the cricoid cartilage . This part of the tract includes the nose , sinuses , pharynx , and larynx . Typical infections of the upper respiratory tract include tonsillitis , pharyngitis , laryngitis , sinusitis , otitis media , certain influenza types, and the common cold . Symptoms of URIs can include cough , sore throat , runny nose , nasal congestion , headache , low-grade fever , facial pressure, and sneezing . The lower respiratory tract consists of

2145-401: Is the bacterium that causes the disease called diphtheria. Bacteriophages introduce a gene into the bacterial cells that makes a strain toxigenic. The strains that are not infected with these viruses are harmless. C. diphtheriae is a rod-shaped, Gram-positive, nonspore-forming, and nonmotile bacterium. C. diphtheriae has shown to exclusively infect humans. It is believed that humans may be

2210-421: Is to exclude other obstructive conditions of the upper airway, especially epiglottitis , an airway foreign body , subglottic stenosis , angioedema , retropharyngeal abscess , and bacterial tracheitis . A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign , because of the subglottic stenosis, which resembles

2275-443: Is uncertainty in the effectiveness and the potential adverse effects and/or side effects are not well known. In cases of possible secondary bacterial infection, the antibiotics vancomycin and cefotaxime are recommended. In severe cases associated with influenza A or B infections, the antiviral neuraminidase inhibitors may be administered. Viral croup is usually a self-limiting disease, with half of cases resolving in

2340-406: Is usually a viral disease, antibiotics are not used unless secondary bacterial infection is suspected. The use of cough medicines , which usually contain dextromethorphan or guaifenesin , are also discouraged. Supportive care for children with croup includes resting and keeping the child hydrated. Infections that are mild are suggested to be treated at home. Croup is contagious so washing hands

2405-575: Is worse at night and normally lasts one to two days. Croup can be caused by a number of viruses including parainfluenza and influenza virus . Rarely is it due to a bacterial infection . Croup is typically diagnosed based on signs and symptoms after potentially more severe causes, such as epiglottitis or an airway foreign body , have been ruled out. Further investigations, such as blood tests, X-rays and cultures, are usually not needed. Many cases of croup are preventable by immunization for influenza and diphtheria . Most cases of croup are mild and

2470-474: The Tox gene. When bound to iron, the aporepressor shuts down toxin production. Elek's test for toxigenicity is used to determine whether the organism is able to produce the diphtheria toxin. To identify C. diphtheriae , a Gram stain is performed to show Gram-positive , highly pleomorphic organisms often looking like Chinese letters. Stains such as Albert's stain and Ponder's stain are used to demonstrate

2535-432: The immune system will resolve such infections. This medicine does not effectively treat a viral infection like sore throats , influenza , bronchitis , sinusitis and common respiratory tract infections. This is because antibiotics were developed to target features of bacteria that are not present in viruses, and so antibiotics are ineffective as antiviral agents . The CDC has reported that antibiotic prescription

2600-420: The larynx , trachea , and large bronchi due to infiltration of white blood cells (especially histiocytes , lymphocytes , plasma cells , and neutrophils ). Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as stridor . Croup is typically diagnosed based on signs and symptoms. The first step

2665-427: The metachromatic granules formed in the polar regions. The granules are called polar granules, Babes Ernst granules or volutin granules . An enrichment medium, such as Löffler's medium , is used to preferentially grow C. diphtheriae . After that, a differential plate known as tellurite agar , allows all Corynebacteria (including C. diphtheriae ) to reduce tellurite to metallic tellurium. The tellurite reduction

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2730-412: The trachea (windpipe), bronchial tubes , bronchioles , and the lungs . Lower respiratory tract infections (LRIs) are generally more severe than upper respiratory infections. LRIs are the leading cause of death among all infectious diseases . The two most common LRIs are bronchitis and pneumonia . Influenza affects both the upper and lower respiratory tracts, but more dangerous strains such as

2795-521: The ICU for adult patients receiving mechanical ventilation for at least 48 hours, and topical antibiotic prophylaxis probably reduces respiratory infections but not mortality. However, the combination of treatments cannot rule out the relevant contribution in the systemic component of the observed reduction of mortality. There is no sufficient evidence to recommend that antibiotics be used to prevent complications from an RTI of unknown cause in children under

2860-435: The ability to metabolize certain nutrients. All may be either toxigenic (and therefore cause diphtheria) or not toxigenic. Strain subtyping involves comparing species of bacteria and categorizing them into subspecies. Strain subtyping also helps with identifying the origin of a certain bacteria's outbreak. However, when it comes to the subtyping of C. diphtheriae , there is not a lot of useful or accurate classification due to

2925-489: The advent of effective immunization . One famous fatality of croup was Napoleon 's designated heir, Napoléon Charles Bonaparte . His death in 1807 left Napoleon without an heir and contributed to his decision to divorce from his wife, the Empress Josephine de Beauharnais . Respiratory infection The upper respiratory tract is considered the airway above the glottis or vocal cords; sometimes, it

2990-599: The age of 5 years old. High-quality clinical research in the form of randomized controlled trials assessed the effectiveness of Vitamin D, another review of poorer quality RCTs addressed the effectiveness of immunostimulants for preventing respiratory tract infections. Despite some uncertainty due to small study sizes, there is some evidence that exercise may reduce severity of symptoms but had no impact on number of episodes or number of symptom days per episode. Viruses that cause RTI are more transmissible at very high or low relative humidity ; ideal humidity for indoor spaces

3055-458: The benefits are short-lived and last for only about 2 hours. If the condition remains improved for 2–4 hours after treatment and no other complications arise, the child is typically discharged from the hospital. Epinephrine treatment is associated with potential adverse effects (usually related to the dose of epinephrine) including tachycardia , arrhythmias , and hypertension . More severe cases of croup may require treatment with oxygen. If oxygen

3120-414: The cell surface receptor and facilitates the delivery of fragment A to the cytosol. Once the bacteria have localized in one area, they start multiplying and create the inflammatory pseudomembrane. Individuals with faucial diphtheria typically have the pseudomembrane grow over the tonsil and accessory structures, uvula, soft palate, and possibly the nasopharyngeal area. In upper respiratory tract diphtheria,

3185-500: The diphtheria vaccine include "mild fever, fussiness, drowsiness or tenderness at the injection site". Although it is rare, the DTaP vaccine may cause an allergic reaction that causes hives or a rash to breakout within minutes of administering the vaccine. The genome of C. diphtheriae consists of a single circular chromosome of 2.5 Mbp, with no plasmids . Its genome shows an extreme compositional bias , being noticeably higher in G+C near

3250-424: The disease and is mandatory in the United States for participation in public education and some professions (exceptions apply). The first step of C. diphtheriae infection involves the toxigenic bacteria colonizing a mucosal layer. In young children, this typically occurs in the upper respiratory tract mucosa. In adults, the infection is limited mostly to the tonsillar region. Some unusual sites of infection include

3315-417: The heart, larynx, trachea, bronchi, and anterior areas of the mouth including the buccal mucosa, the lips, tongue, and the hard and soft palate. The bacteria have a number of virulence factors to help them localize on areas of the respiratory tract, many of which are yet to be fully understood as diphtheria does not affect many model hosts such as mice. One common virulence factor that has been studied in vitro

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3380-439: The highly pernicious H5N1 tend to bind to receptors deep in the lungs. Pulmonary Function Testing (PFT) allows for the evaluation and assessment of airways, lung function, as well as specific benchmarks to diagnose an array of respiratory tract infections. Methods such as gas dilution techniques and plethysmography help determine the functional residual capacity and total lung capacity. To discover whether or not to perform

3445-423: The lack of publicly available resources to identify strains and therefore find the origin of outbreaks. C. diphtheriae produces the diphtheria toxin which alters protein function in the host by inactivating the elongation factor EF-2. This causes pharyngitis and 'pseudomembrane' in the throat. The strains that are toxigenic are ones which have been infected with a bacteriophage . The diphtheria toxin gene

3510-406: The level of alertness ), immediate medical evaluation by a doctor is required. Corticosteroids , such as dexamethasone and budesonide , have been shown to improve outcomes in children with all severities of croup, however, the benefits may be delayed. Significant relief may be obtained as early as two hours after administration. While effective when given by injection , or by inhalation, giving

3575-443: The medication by mouth is preferred. A single dose is usually all that is required, and is generally considered to be quite safe. Dexamethasone at doses of 0.15, 0.3 and 0.6 mg/kg appear to be all equally effective. Moderate to severe croup (for example, in the case of severe stridor) may be improved temporarily with nebulized epinephrine . While epinephrine typically produces a reduction in croup severity within 10–30 minutes,

3640-402: The origin than at the terminus. The Corynebacterium diphtheriae genome is a single circular chromosome that has no plasmids. These chromosomes have a high G+C content which is what contributes to their high genetic diversity. The high content of guanine and cytosine is not constant across the entire genome of the bacteria. There is a terminus of replication around the ~740kb region that causes

3705-459: The patient can be treated at home with supportive care. Croup is usually treated with a single dose of steroids by mouth. In more severe cases inhaled epinephrine may also be used. Hospitalization is required in one to five percent of cases. Croup is a relatively common condition that affects about 15% of children at some point. It most commonly occurs between six months and five years of age but may rarely be seen in children as old as fifteen. It

3770-421: The person is no longer contagious, tests are performed ensure that the bacteria have been cleared. People are then vaccinated prevent further transmission of the disease. The wide-use of the diphtheria vaccine dramatically decreased the rate of infection and allows for primary prevention of the disease. Most people receive a 3-in-1 vaccine that consist of protection against diphtheria, tetanus and pertussis, which

3835-425: The pseudomembrane can grow on the pharynx, larynx, trachea, and bronchi/bronchioles. The pseudomembrane starts off white in color and then later becomes dirty-gray and tough due to the necrotic epithelium. Pseudomembrane formation on the trachea or bronchi will decrease efficiency of airflow. Over time, the diffusion rate in the alveoli decreases due to the lower airflow and decreases the partial pressure of oxygen in

3900-431: The reservoir for this pathogen. However, there has been extremely rare cases in which C. diphtheriae has been found in animals. These infections were only toxigenic in two dogs and two horses. The disease occurs primarily in tropical regions and developing countries . Immunocompromised individuals, poorly immunized adults, and unvaccinated children are at the greatest risk for contracting diphtheria. Mode of transmission

3965-593: The specific strain. Enteroviruses , with the exception of rhinoviruses, tend to peak in the summer. Corynebacterium diphtheriae Corynebacterium diphtheriae is a Gram-positive pathogenic bacterium that causes diphtheria . It is also known as the Klebs–Löffler bacillus because it was discovered in 1884 by German bacteriologists Edwin Klebs (1834–1912) and Friedrich Löffler (1852–1915). These bacteria are usually harmless, unless they are infected by

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4030-433: The systemic circulation, which can cause cyanosis and suffocation. Mode of transmission is person-to-person contact via respiratory droplets (i.e., coughing or sneezing), and less commonly, by touching open sores or contaminated surfaces. A vaccine, DTaP, effectively prevents the disease and is mandatory in the United States for participation in public education and some professions (exceptions apply). The invention of

4095-623: The time of Homer 's ancient Greece , and it was not until 1826 that viral croup was differentiated from croup due to diphtheria by Bretonneau . Viral croup was then called "faux-croup" by the French and often called "false croup" in English, as "croup" or "true croup" then most often referred to the disease caused by the diphtheria bacterium . False croup has also been known as pseudo croup or spasmodic croup. Croup due to diphtheria has become nearly unknown in affluent countries in modern times due to

4160-501: The toxoid vaccine, which provides protection against Corynebacterium diphtheriae , caused a dramatic shift on the bacterium's rate of infection in the United States. Even though the vaccine was first made in the early 1800s, it did not become widely available until the early 1910s. According to the National Health and Nutrition Examination Survey (NHANES), "80 percent of persons age 12 to 19 years were immune to diphtheria" due to

4225-461: The wide use of the vaccine in the United States. Diagnosis of respiratory C. diphtheriae is made based on presentation clinically, whereas non-respiratory diphtheria may not be clinically suspected therefore laboratory testing is more reliant. Culturing is the most accurate kind of testing that will confirm or deny the prevalence of diphtheria toxins. The testing is done by swabbing the possibly infected area, as well as any lesions and sores. When

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