Viral Croup: A Current Perspective

Alexander K.C. Leung, MBBS, FRCPC, FRCP (UK & Irel), FRCPCH; James D. Kellner, MD, FRCPC; David W. Johnson, MD, FRCPC

J Pediatr Health Care. 2004;18(6)

Etiology and Epidemiology

Parainfluenza virus accounts for more than two thirds of cases of viral croup, with type 1 and 2 responsible for the majority of cases (Malhotra & Krilov, 2001; Peltola et al., 2002). Other etiologic agents include influenza virus, respiratory syncytial virus, metapneumovirus, adenovirus, rhinovirus, enterovirus and, rarely, measles virus and herpes simplex virus (Ewig, 2002; McIntosh & McAdam, 2004). When croup is caused by an influenza virus, the clinical picture is usually more severe than that caused by a parainfluenza virus (Peltola et al., 2002).

Croup accounts for approximately 15% of respiratory tract disease seen in the pediatric age group (Cherry, 2004). The condition is most common between the ages of 6 months and 3 years but can occur in children as young as 3 months and as old as 15 years of age; the peak incidence occurs during the second year of life (Thomas & Friedland, 1998). The male to female ratio is approximately 3 to 2 (Knutson & Aring, 2004). The condition is most prevalent in the fall and winter months (Ewig, 2002; Knutson & Aring, 2004). Transmission is by droplets and/or direct contact (Cressman & Myer, 1994).

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Cite this: Viral Croup: A Current Perspective - Medscape - Nov 01, 2004.

Abstract and Introduction
Etiology and Epidemiology
Pathogenesis and Clinical Manifestations
Differential Diagnosis
Management
Conclusion
Box: Differential Diagnosis of Viral Croup

Table 1. Westley Croup Scoring System
Symptom	Score
Level of consciousness
Normal (including sleep)	0
Disoriented	5
Cyanosis
None	0
Cyanosis with agitation	4
Cyanosis at rest	5
Stridor
None	0
When agitated	1
At rest	2
Air entry
Normal	0
Decreased	1
Markedly decreased	2
Retractions
None	0
Mild	1
Moderate	2
Severe	3

Data from Westley, C. R., et al. (1978).

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