11/36. Branhamella catarrhalis and croup: toxicity in the upper respiratory tract. Branhamella catarrhalis has gained increasing recognition as a pathogen in the respiratory tract. During the past 18 years, since its transfer from the genus neisseria, it has been associated with infection in cavities of the respiratory tract (sinuses and middle ear). It has been recognized as playing a role in laryngitis. Its isolation in large numbers from the surface and core of acutely and chronically infected tonsils indicates a possible role in these infections. croup (two patients reported here) can now be added to this list. The toxic potential of B catarrhalis, its movement from commensal to pathogen for the upper respiratory tract, and the pathogenic mechanisms by which this has occurred are reviewed. ( info) |
12/36. A child with nocturnal croup. The domiciliary management of a four-year-old with suspected croup is difficult. The differential diagnosis ranges from relatively benign viral illnesses to acute epiglottitis and even diphtheria. Complete obstruction can occur with little warning, and the social situation may further complicate arrangements. As it is not possible to admit every patient with such symptoms, clinical judgement is vitally important. ( info) |
13/36. Acute viral laryngotracheitis complicated by herpes simplex virus infection. We report the development of HSV-1 laryngotracheitis during the resolution phase of typical viral laryngotracheobronchitis (LTB) in an infant. This case represents an uncommon complication of viral LTB which has previously been described only at autopsy and suggests that prolonged use of systemic corticosteroids may lead to secondary infections, such as HSV-1. Therefore, we recommend that corticosteroid therapy for LTB be limited to 48 degrees in duration. This case also demonstrates that when an atypical clinical course is being followed by a patient who has LTB, then early diagnostic intervention is indicated. If HSV-1 is identified, anti-viral chemotherapy should be initiated and artificial airway management may be necessary. Tracheal intubation may be used, but, if extensive subglottic ulceration occurs, the subglottis should be bypassed in order that the chance of subglottic stenosis be minimized. In this case, early identification by bronchoscopy and viral cultures resulted in a successful combined medical-surgical management and total resolution with no sequelae. ( info) |
| An 8-year-old boy with bacterial tracheitis, treated by endotracheal intubation, humidification, airway toilet and antibiotics, experienced a toxic shock syndrome on the day after his admission. The course was favourable. staphylococcus aureus was isolated from tracheal secretions. Bacterial tracheitis is an infrequent cause of non-menstrual toxic shock syndrome. The diagnosis of bacterial tracheitis should be suspected in a child with toxicity and croup who is not responding to the usual therapy. endoscopy should be performed allowing for removal of the secretions. The maintenance of a clear airway is the main purpose of the treatment. ( info) |
15/36. Nebulised adrenaline 1:1000 in the treatment of croup. A case of infective croup is described which was successfully treated using nebulised adrenaline 1:1000. The diagnosis of croup and the basis for the use of nebulised adrenaline are discussed. ( info) |
16/36. intubation for the membranous laryngotracheobronchitis. A 49-year-old housewife with membranous laryngotracheobronchitis (the membranous croup) was referred to our clinic because of difficulty in breathing. Instant intubation in the emergency room did not relieve her breathing trouble, thus, following emergency tracheostomy accompanied by irrigation with mucolytic agents and antibiotics proved effective. Preceding intratracheal intubation made the patient suffocate because it induced membranous debris to detach and become lodged in the tracheal wall. In addition, dryness seemed to worsen her respiratory distress, thus high humidification was felt to be instrumental in relieving her symptoms. No pathological bacteria were found in specimens detached from the tracheal wall. ( info) |
| Impacted subglottic foreign bodies may produce upper airway obstruction and clinical signs simulating croup or asthma. We identified the roentgenologic and clinical features in six patients. In four of these patients, the parent had not observed the aspiration episode, so that the diagnosis was delayed. Roentgenologic studies demonstrated subglottic narrowing of the upper airway with a homogeneous, poorly defined radiodensity within the narrowed segment. These roentgenologic studies are usually diagnostic; therefore, if infants or young children present with stridor of undetermined cause, soft-tissue upper airway roentgenography is indicated. ( info) |
18/36. Postintubation croup in two consecutive patients undergoing cleft lip and/or palate repair. Postintubation croup is not common, but it is potentially serious complication of surgery and anesthesia. We report 2 consecutive cases of postintubation croup in infants undergoing cleft lip and/or palate repair, each occurring after an uncomplicated postoperative course of 48 hours' duration. ( info) |
19/36. Efficacy of helium--oxygen mixtures in the management of severe viral and post-intubation croup. An appreciable number of children with viral or post-intubation croup progress to respiratory failure necessitating an artificial airway. We report seven such patients with critical airway narrowing in whom we reduced the work of breathing by developing helium rather than air as a carrier gas for oxygen. Assessment of patients by a croup-scoring system and blood gas analysis suggests helium-oxygen mixtures to be a useful alternative to intervention with tracheostomy or tracheal intubation. The rationale and limitations of this treatment are discussed. ( info) |
20/36. Oesophageal candidiasis and croup in a child with defective neutrophil motility. Severe oesophageal candidiasis and croup due to involvement of the larynx developed insidiously in a girl aged 20 months. There had been delayed separation of the umbilical cord and repeated infections associated with a defect of neutrophil motility. The significance of the early clinical features was not fully appreciated and the diagnosis considered only when stricture of the oesophagus became evident. She was treated with oral ketoconazole 100 mg daily. After one month's treatment there was striking radiological improvement apart from the persistence of the oesophageal stricture. The croup resolved completely but there was only partial relief of dysphagia because of the residual stricture. We would emphasis that candidiasis should be anticipated and treated vigorously in children with such a defect of neutrophil motility. ( info) |