croup

Definition

Croup is a common childhood ailment. Typically, it arises from a viral infection of the larynx (voice box) and is associated with mild upper respiratory symptoms such as a runny nose and cough. The key symptom is a harsh barking cough. Croup is usually not serious, and most children recover within a few days. In a small percentage of cases, a child develops breathing difficulties and may need medical attention.

Description

At one time, the term croup was primarily associated with diphtheria, a life-threatening respiratory infection. Owing to widespread vaccinations, diphtheria has become rare in the United States, and croup currently refers to a mild viral infection of the larynx. Croup is also known as laryngotracheitis, a medical term that describes the inflammation of the trachea (windpipe) and larynx.

Parainfluenza viruses are the typical root cause of the infection, but influenza (flu) and cold viruses may sometimes be responsible. All of these viruses are highly contagious and easily transmitted between individuals via sneezing and coughing. Children between the ages of three months and six years are usually affected, with the greatest incidence at one to two years of age. Croup can occur at any time of the year, but it is most typical during early autumn and winter. The characteristic harsh barking of a croupy cough can be very distressing, but it rarely indicates a serious problem. Most children with croup can be treated very effectively at home; however, 1–5% may require medical treatment.

Croup may sometimes be confused with more serious conditions, such as epiglottitis or bacterial tracheitis. These ailments arise from bacterial infection and must receive medical treatment.

— Julia Barrett

[From dialectal croup, to croak.]

[Middle English croupe, from Old French, of Germanic origin.]

For more information on croup, visit Britannica.com.

Definition

Croup is a common ailment of early childhood involving inflammation of the larynx, trachea, bronchial tubes, and lungs. The condition is characterized by a harsh, barking cough, wheezing, and difficulty in breathing.

Description

Croup is most likely to be found in children between the ages of three months to six years. Most incidences occur during the cold weather seasons.

Spasmodic croup is usually mild and may be due to bacterial infection or allergies. For the most part, the child will not have a fever. Viral croup, also called laryn-gotracheobronchitis, is more severe and is often accompanied by fever. Both types follow a very similar course, which depends on the severity of the illness.

In many instances, a child may have had a cold or the flu just before the onset of croup symptoms. These symptoms tend to come on very suddenly. It is not uncommon for a child with croup to waken in the middle of the night coughing violently and gasping for breath. In fact, the croup symptoms will usually be worse at night and get better during the day.

Causes & Symptoms

During the immune system response to an infection or an allergic reaction, the respiratory passages become swollen, and they are congested with mucus and fluid. They also become more and more irritated. There is a great deal of coughing, and the child may become hoarse. The airways are narrowed, and the breathing is difficult and noisy. This leads to the characteristic symptom of stridor, or noisy aspiration, as the child attempts to draw in air through narrowed passages. The constriction of these airways is usually accompanied by a high-pitched cough, often described as sounding like the bark of a seal.

Diagnosis

Diagnosis of croup is primarily based on a good history taken by the health care provider, including the physical symptoms of the illness, the presentation of the illness, and its progression. If a physical exam is performed, it will probably include listening with a stethoscope for the breathing sounds which are characteristic of croup. When the symptoms appear to be severe, or the history suggests it, x rays may be taken to rule out epiglottitis (infection of the epiglottis) or aspiration of a foreign body, which are emergency situations.

Treatment

Supportive Measures

Most treatment can be done at home, using relaxing and supportive measures to relieve symptoms. Steam inhalation is quite helpful in this respect. A cool-mist humidifier is recommended, as a hot vaporizer is often hazardous, especially around young children.

One of the best ways to produce a lot of moist air in a short time, is to make use of the bathroom shower. The procedure is to close the bathroom door and turn on the cool water shower faucet full blast. Then the child can be a held while seated on a chair or the closed commode, breathing in steam as it fills the room. This can be done for up to 15 minutes, and often brings instant relief from congestion.

Cool air seems to relax and soothe the respiratory system. Therefore, taking a car ride with the window rolled will sometimes effect good results in reducing the coughing associated with croup.

There is a strong possibility of dehydration due to the illness. Increasing fluid intake as much as possible and insuring plenty of rest will enhance immune functioning, helping the body to help itself. In addition, smoking should be prohibited within the house.

Herbs

Respiratory herbs can be used to soothe swollen and irritated tissues, reduce inflammation, and gently loosen and expel mucus. The following herbs should be given three times per day diluted in water or other liquids until symptoms are gone:

• Grindelia spp., gum weed, 1-2 ml
• Sambucus nigra,elder flowers, 2-4 ml
• Glycyrrhiza glabra,licorice root, 1-3 ml
• Verbascum thapsus,mullein, 2-4ml
• Astragalus senticocosus, 2-4 ml (This herb is an immune system stimulant and should be given as a preventative for those who have chronic bouts of croup.)

Slippery elm bark can also be taken, as it is soothing to the throat.

Homeopathy

Aconite is the most favored remedy to use for croup. If it does not work, Spongia can be tried, especially if the breathing sounds as if wood were being sawed. Alternately, try Hepar sulphuris, indicated by a mucus-filled cough. Give a dosage of 12X or 30C every 30 minutes until the child is able to fall asleep.

Allopathic Treatment

In most cases, croup can be easily and successfully treated at home. However, if the symptoms become severe, the child will need to be seen by a physician. Prompt medical attention is needed if:

• The child's fever goes up to 104°F (39.9°C).
• The child seems pale or bluish around the mouth or fingernails.
• The child refuses all liquids or can't swallow.
• The child is drooling a great deal.
• The child's breathing becomes increasingly rapid or difficult.

Severe cases may warrant the use of inhalants, such as epinephrine, to reduce swelling and give the child easier breathing. Inhalants have limited effectiveness over time, and care must be taken to avoid undesirable side effects. Oxygen may also be administered in more severe cases. Corticosteroids are given to decrease pain and swelling.

If a child is hospitalized for further observation or treatment, intravenous (IV) fluids may be given to reduce dehydration. In a few very severe cases, a tube has to be inserted through the nose or mouth (intubation) to keep the airway passage open for breathing. There is a slight risk of injury to the respiratory system during the introduction and the removal of the tube.

Expected Results

Croup ordinarily lasts three to seven days. Most cases are mild and gradually improve with care. Some children have recurring bouts with croup, but they usually outgrow this by seven years of age.

It is important to monitor a child with croup throughout the night. An adult should probably consider sleeping or resting nearby. If the child is having a serious struggle with breathing, emergency services should be contacted immediately. This means either calling 911 or making a trip to the nearest emergency room. Hospital visits are necessary in about one to 15% of the reported cases of croup.

Prevention

Croup is generally the result of an infectious disease. Avoiding exposure to others with respiratory infections is the best way to avoid getting croup. Children should be taught to maintain good hygiene practices such as not eating food from the silverware or dishes of others and washing their hands. Care should be taken with colds and the flu so that there is no progression to symptoms of croup.

In general, an adequate intake of vitamins A and C, bioflavonoids, and zinc can help to prevent the respiratory infections and allergic reactions that lead to croup.

Resources

Books

Bunch, Bryan, ed. The Family Encyclopedia of Diseases: a Complete and Concise Guide to Illnesses and Symptoms. New York: Scientific Publishing, Inc., 1999.

The Editors of Time-Life Books. The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments. Alexandria, VA: Time-Life, Inc., 1997.

Other

"Childhood Infections" The Nemours Foundation. http://kidshealth.org. (1999).

"The Common Cold" Natural Medicine Online. http://www.nat-med.com. (2000).

"Croup" Merck & Co., Inc. http://www.merck.com.

"Croup and Your Young Child" American Academy of Pediatrics. http://www.aap.org. (2000).

[Article by: Patience Paradox]

Definition

Croup is one of the most common respiratory illnesses in children. It is an inflammation of the larynx and the trachea. When a child has croup, that portion of the airway just below the vocal cords narrows and becomes swollen, making breathing both noisy and labored.

Description

Croup is a broad term describing a group of illnesses that affect the larynx, trachea, and bronchi. The key symptom is a harsh, barking cough. One of the most common respiratory illnesses in children, croup is frequently noted in infants and children and can have a variety of causes. Before the days of antibiotics and immunizations, croup was a dreaded and often deadly disease usually caused by the diphtheria bacteria. Though in the early 2000s cases of croup are normally mild, it can still be dangerous. Croup affects the vocal cords and the area just below, the voice box, or larynx, and the windpipe, or trachea. The lower breathing passages (bronchi) may also be affected. Swelling of these areas causes the airway to narrow, which makes breathing difficult. It is also sometimes called laryngotracheitis, a medical term describing the inflammation of the trachea and larynx.

The characteristic symptoms of croup can be better understood by knowing the anatomic makeup of a child's larynx. Small children typically have quite a narrow larynx, so even a slight decrease in the airway's radius may lead to a large decrease in the air flow, leading to the symptoms of croup.

There are two primary types of croup: viral and spasmodic. Viral croup is caused by a viral infection in the trachea and larynx. It often starts with a cold that over time develops into a barking cough. When the child's airway becomes increasingly swollen and more mucus is secreted, it becomes more challenging to breathe. Breathing gets increasingly noisy, and a condition known as stridor may occur. (Stridor is a sign of respiratory obstruction that presents as a high-pitched, coarse, musical sound that occurs during breathing.) Children with viral croup usually have a low-grade temperature, but a few may have fevers up to 104°F (40°C). As breathing requires more effort, the child may stop eating and drinking. The child may also become too fatigued to even cough. If the airway continues to swell, it may approach a point at which the child can no longer breathe. Stridor is fairly common with a mild case of croup, especially if the child is active or crying. However, if a child has stridor at rest, the child may have severe croup. Symptoms are usually worse at night. The symptoms peak between 24 and 48 hours and usually resolve within one week.

Spasmodic croup is usually precipitated by an allergy or mild upper respiratory infection. It can be quite alarming, both because of the noise of the cough and because it usually comes on suddenly in the middle of the night. A child may go to sleep with a mild cold and wake up a few hours later, gasping for air. In addition, the child may have a cough that sounds like a seal barking, and will have a hoarse voice. Children with spasmodic croup normally do not have a fever.

Spasmodic croup can sometimes be difficult to differentiate from viral croup. Although spasmodic croup is associated with the same viruses that cause viral croup, spasmodic croup tends to recur and may be an indication of some type of allergic reaction instead of a direct infection.

Transmission

The viruses causing croup are highly contagious and easily transmitted between individuals through sneezing and coughing. It is usually transmitted via the respiratory route, entering through the nose and nasopharynx.

Demographics

Croup accounts for about 15 percent of all respiratory tract infections in children seen by physicians. It typically is seen in late fall and winter, and primarily occurs in children aged six months to three years. It has an annual peak incidence of 50 new cases per 1,000 children during the second year of life. Males are twice as likely as females to get the disease. The incidence decreases significantly after age six.

Causes and Symptoms

Croup is most commonly brought on by a viral infection. The parainfluenza viruses (types 1, 2, and 3) are the most frequent causes of croup, accounting for approximately 75 percent of all cases diagnosed. Human parainfluenza virus 1 (HPIV-1) is the most common cause. Croup may also be caused by influenza A and B, adenovirus, measles, and respiratory syncytial virus (RSV). Other possible causes of croup are bacteria, inhaled irritants, allergies, and acid reflux.

The following are usually true of viral croup:

• It commonly occurs in individuals between the ages six months to six years.
• Stridor, and the classic barking cough are usually present.
• The child may have a fever.
• Wheezing may be present.
• It usually lasts two to seven days.

The following items are characteristic of spasmodic croup:

• The symptoms come on suddenly, often in the middle of the night.
• Stridor occurs along with the barking cough.
• It typically lasts two to four hours.

When to Call the Doctor

Most cases of croup can be safely managed at home, but parents should call their child's doctor for advice, even if it is in the middle of the night. Call 911 for emergency help if any of the following is true:

• The croup is possibly caused by an inhaled object or by an insect sting.
• The child is drooling.
• The child has blue lips or skin.
• The child has a very high fever.
• The child is very anxious, has rapid breathing, and/or is struggling to get a breath.
• The child insists on sitting up or complains of a sore throat and is drooling. This is a possible indication that he or she may have a disease called epiglottitis, which is potentially life-threatening.
• The child makes a whistling sound that gets louder with each breath.
• The child has stridor when resting.

Diagnosis

The diagnosis of croup is usually made based on the description of symptoms by the parent, as well as a physical examination. Sometimes other studies, such as x rays, may be required. The doctor may note chest retractions with breathing and may hear wheezing and decreased breath sounds when listening to the chest with a stethoscope. Sometimes a foreign object or narrowing of the trachea is seen on a neck x ray.

Treatment

The most important part of treating patients with croup is maintaining an open airway. If a child wakes up in the middle of the night with croup, he or she should be taken to the bathroom. The door should be closed and the shower turned on to allow the bathroom to steam up. The parent should then sit in the steamy bathroom with the child. The moist, warm air should assist the child in breathing within 15 to 20 minutes, though the child will still have the barking cough. For the rest of that night and for two to three nights following, a humidifier or cold-water vaporizer should be placed in the child's room. If another attack of croup recurs that night or the next, the steam treatment should be repeated. If the steam does not work, sometimes taking the child outside, where he or she can inhale the cool, moist night air will be enough to improve breathing. Though a study in the early 2000s cast some doubt on the efficacy of using steam or mist, it does seem to be helpful for most children with croup. Parents may also give acetaminophen to reduce fevers and increase the child's comfort level. Cough medicines should usually be avoided.

Several other treatments are possible if the croup is severe enough to warrant the child's being seen by a physician. Aerosolized racemic epinephrine as well as oral dexamethasone (a steroid) may be used to help shrink the upper airway swelling. A bacterial infection will require antibiotics. If the airway becomes increasingly obstructed, the child may require intubation (the placing of a tube through the nose or mouth through the larynx into the main air passage to the lungs.) If the patient is dehydrated, intravenous fluids will be administered.

Prognosis

Croup is normally a self-limiting disease with an excellent prognosis. Only a few who are diagnosed require hospitalization, and less than 5 percent require intubation. If proper airway management is maintained, death is rare. There is some speculation that children with a history of croup may be at a higher risk for developing asthma, but the evidence was not clear as of 2004.

Prevention

The best way to prevent croup is to prevent the causative infections. Parents should practice excellent hand washing, especially during the cold and flu season, and avoid close contact with anyone who has a respiratory infection.

Parental Concerns

The onset of croup can be frightening, especially when it comes on suddenly. Parents can help their child by not panicking or appearing anxious, as this may increase anxiety in the child, which can worsen symptoms. If they are at all unsure about how their child is responding to home treatment, parents should not hesitate to seek medical advice or treatment, no matter the time of day or night.

See also Influenza.

Resources

Periodicals

Colletti, James E. "Myth: Cool Mist Is an Effective Therapy in the Management of Croup." Canadian Journal of Emergency Medicine 6 (September 2004): 5, 357–9.

Knutson, Doug, and Ann Aring. "Viral Croup." American Family Physician 69 (February 1, 2004): 3, 535–40.

"Patient Education Guide: What to Do When Your Child Has Croup." Journal of Respiratory Diseases 23 (March 2002): 23, 192–5.

Organizations

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007–1098. Web site: www.aap.org.

Web Sites

"Croup." MedlinePlus. Available online at www.nlm.nih.gov/medlineplus/ency/article/000959.htm (accessed January 11, 2005).

[Article by: Deanna M. Swartout-Corbeil, RN]

1. the muscular area around and above the base of the tail in the horse.
2. acute obstruction of the larynx caused usually by allergy or respiratory infection. Used with reference to children and chickens.

Croup also refers to the rump of a quadruped and the crop of a bird. For the work of a casino employee, see croupier.

Croup
Classification and external resources
The steeple sign as seen on an AP neck X-ray of a child with croup.
ICD-10	J05.0
ICD-9	464.4
DiseasesDB	13233
MedlinePlus	000959
eMedicine	ped/510 emerg/370 radio/199
MeSH	D003440

Croup is a group of respiratory diseases that often affects infants and children^[1] under age 6. It is characterized by a barking cough; a whistling, obstructive sound (stridor) as the child breathes in; and hoarseness due to obstruction in the region of the larynx. It may be mild, moderate or severe, and severe cases, with breathing difficulty, can be fatal if not treated in a hospital.^[2] Another type of croup is known as spasmodic croup. People with spasmodic croup first catch a cold, rarely with fever, and then the croupy cough begins. In some cases spasmodic croup may begin suddenly without any preceding cold symptoms. Unlike viral croup, spasmodic croup usually recurs, can occur in older children, and rarely even in adults. Spasmodic croup is thought to be related to allergies.

Contents 1 Presentation 2 Signs and symptoms 3 Classification 4 Causes 5 Treatment 6 Prognosis 7 References 8 External links

Presentation

Croup affects 5% of children in the second year of life; the peak incidence is 3 months to 3 years. The group of respiratory diseases consists of spasmodic croup, acute laryngotracheitis, laryngotracheobronchitis (LTB), laryngotracheobronchopneumonitis (LTBP), and laryngeal diphtheria. LTB and LTBP, which usually involve a bacterial infection, are usually severe.^[2]

The first step in diagnosis is to exclude other acute obstructive illnesses in the region of the larynx, such as epiglottitis, a foreign body, or angioneurotic edema of the epiglottis. Misdiagnosing an obstructive airway disease can be fatal.^[2]

Signs and symptoms

Croup is characterized by a harsh "barking" cough and sneeze, inspiratory stridor (a high-pitched sound heard on inhalation), nausea/vomiting, and fever. Hoarseness is usually present. More severe cases will have respiratory distress.

The "barking" cough (often described as seal-like)^[3] of croup is diagnostic. Stridor will be provoked or worsened by agitation or crying. If stridor is also heard when the child is calm, critical narrowing of the airway may be imminent.

In diagnosing croup, it is important for the physician to consider and exclude other causes of shortness of breath and stridor, such as foreign body aspiration and epiglottitis.

On a frontal X-ray of the cervical vertebrae, the steeple sign suggests the diagnosis of croup.

Classification

One tool for measuring the severity of croup is the Westley croup score, which describes specific features of physical examination^[4]

The Westley Score: Classification of croup severity

Feature	Severity
Chest wall retraction	None = 0	Mild = 1	Moderate = 2	Severe = 3
Stridor	None = 0	With agitation = 1	At rest = 2
Cyanosis	None = 0	With agitation = 4		At rest = 5
Level of consciousness	Normal = 0 (including sleep)	Disoriented = 5
Air entry	Normal = 0	Decreased = 1	Markedly decreased = 2

• A Westley score of ≤2 designates mild croup. The characteristic barking cough and hoarseness may be present but without resting stridor.

• A score of 3 to 7 is classed as moderate croup, and typically there will be signs of increased respiratory effort, including accessory muscle recruitment and sternal recession.

• A score of ≥8 indicates severe croup, and these children are at the greatest risk of respiratory failure. There is marked in drawing of the sternum, and the child may become fatigued and distressed.

One alarming feature is the reduction of stridor in a child previously demonstrating severe obstructive signs. With worsening airway obstruction, air movement is so limited that the characteristic sound is lost.

Causes

Croup is most often caused by parainfluenza virus, primarily types 1 and 2 (some definitions limit the term "croup" to this pathogen).^[5] However, other viral and possibly bacterial infections can also cause it. Approximately 75% of cases are caused by parainfluenza virus. Influenza A and B, Measles, adenovirus and (RSV) respiratory syncytial virus are other viruses that sometimes cause croup. It is most common in the fall and winter but can occur year-round, with a slight predilection for males.

The respiratory distress is caused by the inflammatory response to the infection, rather than by the infection itself. It usually occurs in young children as their airways are smaller and differently shaped than adults', making them more susceptible. There is some element of genetic predisposition as children in some families are more susceptible than others.

An entity known as spasmodic croup also occurs, distinct from the infectious variety, due to laryngeal spasms.

Treatment

The treatment of croup depends on the severity of symptoms.

The Alberta Clinical Practice Guideline Working Group has developed guidelines for diagnosing and treating croup, including a scoring system for classifying severity.^[6] The severe form (which affected less than 1% of children seen in the emergency department) involves breathing difficulties, indicated by stridor, chest retractions, agitation and distress. Lethargy or decreased level of consciousness is a sign of impending respiratory failure, and requires emergency medical treatment. LTB and LTBP are usually severe, and require treatment in the intensive care unit, with a endotracheal (ET) tube to assist breathing, and antibiotics.^[2]

The routinely recommended treatment is with corticosteroids, although corticosteroids suppress the immune system and can predispose the child to infection. There is a debate over how many doses to give, but Cherry in the New England Journal of Medicine recommends one dose, and has observed that children with viral, bacterial and fungal complications have had multiple doses. Epinephrine produces a significant reduction in the croup severity score but the benefit only lasts for 2 hours. Children who have moderate or severe croup with blood oxygen saturation under 92% should receive oxygen.^[2]

Since laryngotracheitis is a viral disease (most commonly parainfluenza virus 1) antibiotics have no value.

Croup can be prevented by immunization for influenza and diphtheria. At one time, croup referred to a diphtherial disease, but with vaccination diphtheria is rare.^[2]

One of the traditional ways to treat croup is to inhale hot steam. However, studies have found that this is not effective.^[2] This was the sole treatment for croup throughout the nineteenth and most of the twentieth century.^{[citation needed]} Hospitals today use a "blowby" apparatus for this purpose. Simpler remedies include taking the child outside in moist night air, or alternatively exposing the child to steam from a hot bath or a humidifier. There is little or no evidence to support their efficacy.

Mild croup with no stridor, or stridor only on agitation, and just a cough may simply be observed, or a dose of inhaled, oral, or injected steroids may be given. When steroids are given, dexamethasone is often used, due to its prolonged physiologic effects.

Moderate to severe croup may require nebulized adrenaline in addition to steroids. Oxygen may be needed if hypoxia develops. Children with moderate or severe croup are typically hospitalized for observation, usually for less than a day. Intubation is rarely needed (less than 1% of hospitalized patients).

Prognosis

Viral croup is a self-limited disease, but can very rarely result in death from complete airway obstruction. Symptoms may last up to 7 days, but typically peak around the second day of illness. Rarely, croup can be complicated by, (or confused with) an acute bacterial tracheitis, which is more dangerous.

References

1. ^ Croup at Dorland's Medical Dictionary
2. ^ ^{a b c d e f g} Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359. http://content.nejm.org/cgi/content/full/358/4/384. 
3. ^ "Croup - Lucile Packard Children's Hospital". 2007-01-05. http://www.lpch.org/diseasehealthinfo/healthlibrary/respire/croup.html. 
4. ^ Clinical Features, Evaluation and Diagnosis of Croup, UpToDate (Accessed 6-10-2009)
5. ^ Croup at eMedicine Dictionary
6. ^ Guideline for the Diagnosis and Management of Croup, Administered by the Alberta Medical Association, 2008 Update

External links

Look up croup in Wiktionary, the free dictionary.

• MayoClinic
• Four kinds of Croup
• Clinical Management notes

v • d • e Pathology of respiratory system (J, 460-519), respiratory diseases Upper RT (including URTIs, Common cold) Head sinuses: Sinusitis nose: Rhinitis (Vasomotor rhinitis, Atrophic rhinitis, Hay fever) · Nasal polyp · Rhinorrhea · nasal septum (Nasal septum deviation, Nasal septum perforation, Nasal septal hematoma) tonsil: Tonsillitis · Adenoid hypertrophy · Peritonsillar abscess Neck pharynx: Pharyngitis (Strep throat) larynx: Laryngitis · Croup · Laryngospasm · vocal folds: Vocal fold nodule · epiglottis: Epiglottitis trachea: Tracheitis · Tracheal stenosis Retropharyngeal abscess Lower RT/lung disease (including LRTIs) Bronchial/ obstructive acute: Acute bronchitis chronic: COPD (Chronic bronchitis, Emphysema, Diffuse panbronchiolitis) · Asthma (Status asthmaticus) · Bronchiectasis unspecified: Bronchitis · Bronchiolitis (Bronchiolitis obliterans) Interstitial/ restrictive External agents/ occupational lung disease Pneumoconiosis (Asbestosis, Baritosis, Bauxite fibrosis, Berylliosis, Caplan's syndrome, Chalicosis, Coalworker's pneumoconiosis, Siderosis, Silicosis, Byssinosis) Hypersensitivity pneumonitis (Bagassosis, Bird fancier's lung, Farmer's lung) Other ARDS · Pulmonary edema · Löffler's syndrome/Eosinophilic pneumonia · Respiratory hypersensitivity (Allergic bronchopulmonary aspergillosis) Hamman-Rich syndrome · Idiopathic pulmonary fibrosis · Sarcoidosis Obstructive or restrictive Pneumonia/ pneumonitis By pathogen Viral · Bacterial (Pneumococcal, Klebsiella) / Atypical bacterial (Mycoplasma, Legionnaires' disease, Chlamydiae) · Fungal (Pneumocystis) · Parasitic · noninfectious (Chemical/Mendelson's syndrome, Aspiration/Lipid) By vector/route Community-acquired · Healthcare-associated · Hospital-acquired By distribution Broncho- · Lobar IIP UIP · DIP · BOOP-COP · NSIP · RB Other Atelectasis · circulatory (Pulmonary hypertension, Pulmonary embolism) · Lung abscess Pleural cavity/ mediastinum Pleural disease Pleuritis/pleurisy Pneumothorax/Hemopneumothorax (Tension pneumothorax) Pleural effusion: Hemothorax · Hydrothorax · Chylothorax · Empyema/pyothorax · Malignant Fibrothorax Mediastinal disease Mediastinitis · Mediastinal emphysema Other/general Respiratory failure · Influenza · SARS · Idiopathic pulmonary haemosiderosis · Pulmonary alveolar proteinosis respiratory system navs: anat nose,larynx/lower+thoracic cavity/physio/dev, noncongen/congen/tumors, symptoms+signs/eponymous, proc

v • d • e Common cold Viruses Rhinovirus - Coronavirus - Human parainfluenza viruses - Human respiratory syncytial virus - Adenovirus - Enterovirus - Metapneumovirus Symptoms Pharyngitis - Rhinorrhea - Nasal congestion - Sneezing - Cough - Muscle aches - Fatigue - Malaise - Headache - Weakness - Loss of appetite Complications Acute bronchitis - Bronchiolitis - Croup - Pneumonia - Sinusitis - Otitis media - Strep throat Antiviral drugs Pleconaril (experimental)

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Dansk (Danish)
1.
n. - kryds, bagpart

2.
n. - strubehoste, krup

Nederlands (Dutch)
kroep

Français (French)
1.
n. - croupe (de cheval)

2.
n. - (Méd) croup

Deutsch (German)
1.
n. - Kruppe, Kreuz, Hinterteil (bes. von Pferden)

2.
n. - Krupp

Ελληνική (Greek)
n. - διφθεριτική λαρυγγίτιδα (κν. χλαπάτσα)

Italiano (Italian)
difterite

Português (Portuguese)
n. - garupa (f), crupe (m) (Med.)

Русский (Russian)
круп

Español (Spanish)
1.
n. - crup, garrotillo

2.
n. - anca, grupa, posaderas

Svenska (Swedish)
n. - krupp, kruppa (anat.)

中文（简体）(Chinese (Simplified))
1. 格鲁布性喉头炎

2. 臀部

中文（繁體）(Chinese (Traditional))
1.
n. - 格魯布性喉頭炎

2.
n. - 臀部

한국어 (Korean)
1.
n. - 위막성 후두염

2.
n. - 엉덩이

日本語 (Japanese)
n. - 偽膜性喉頭炎
v. - クルピエをする

العربيه (Arabic)
‏(الاسم) مرض يصيب الأطفال‏

עברית (Hebrew)
n. - ‮אסכרה, דלקת גרון‬
n. - ‮עכוז של בעל-חיים‬

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