Etiopathogenesis, Clinical Features, and Management of Acute Laryngotracheobronchitis

Introduction

Acute laryngotracheobronchitis, commonly known as croup, is a viral infection affecting the upper and lower respiratory tract, primarily in pediatric patients. It leads to inflammation of the larynx, trachea, and bronchi, causing characteristic symptoms such as a barking cough and stridor.

Etiopathogenesis

Croup is most commonly caused by the parainfluenza virus, particularly types 1 and 2. Other viral pathogens include influenza, respiratory syncytial virus (RSV), and adenovirus. The infection leads to mucosal inflammation, edema, and narrowing of the airway, resulting in respiratory distress.

Clinical Presentation and Symptoms

Early Symptoms

• Low-grade fever
• Nasal congestion
• Mild cough

Progressive Symptoms

• Hoarseness
• Barking cough
• Inspiratory stridor
• Respiratory distress in severe cases

Diagnosis

Diagnosis is primarily clinical, based on characteristic symptoms. Imaging, such as a neck X-ray, may show the classic 'steeple sign' indicating subglottic narrowing.

Management

Supportive Care

• Humidified air
• Hydration
• Antipyretics for fever

Pharmacological Treatment

• Corticosteroids (e.g., dexamethasone) to reduce inflammation
• Nebulized epinephrine for severe cases
• Oxygen therapy if hypoxia is present

Conclusion

Acute laryngotracheobronchitis is a common pediatric condition that requires prompt recognition and appropriate management to prevent complications. Supportive care and corticosteroids remain the cornerstone of treatment.