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  • Snapshot
    • A 4-year-old girl presents to the emergency room for a cold. For the past day, she has had a low-grade fever and has been having increasing difficulty breathing. She has a very loud cough, almost like a seal barking, according to her mother. On physical exam, she has notable inspiratory stridor, accessory muscle use, and a barking cough. She is immediately given a single dose of steroids and given racemic epinephrine with some improvement.
  • Introduction
    • Classification
      • parainfluenza virus
        • an enveloped, nonsegmented, linear (-) single-stranded RNA virus
          • must have its own RNA-dependent RNA polymerase in order to replicate
        • helical structure
        • a paramyxovirus
      • transmission via respiratory secretions
    • Epidemiology
      • demographics
        • causes croup and bronchiolitis in children
      • location
        • lungs
    • Pathogenesis
      • virus has 3 virulence factors
        • hemagglutinin in the membrane
          • binds sialic acid and aids in viral entry into cells
        • neuraminidase
          • helps propagate viral progeny
        • fusion proteins
          • multi-nucleated giant cells
          • helps mediate virus and cell membrane fusion, ultimately resulting in infection of the host cell
      • primarily infects epithelial cells of the nasopharynx and then travels to the airways
    • Associated conditions
      • most commonly causes croup in children, also known as acute laryngotracheobronchitis
      • bronchiolitis in children < 2 years of age
      • pneumonia
    • Prognosis
      • most cases resolve without complications
  • Presentation
    • Symptoms
      • “seal-like” barking cough in croup
      • difficulty breathing
    • Physical exam
      • fever
      • inspiratory stridor
      • accessory muscle use
      • pulsus paradoxus with severe croup and upper airway obstruction
  • Imaging
    • Chest radiography
      • indication
        • all patients
      • findings
        • in croup, may show a steeple sign indicating subglottic narrowing
  • Studies
    • Making the diagnosis
      • based on clinical presentation
  • Differential
    • Acute epiglottitis
      • distinguishing factors
        • patients typically have drooling, high fever, and dysphagia
        • a medical emergency
        • absence of barking cough
  • Treatment
    • Management approach
      • management depends on whether patients have bronchiolitis or croup or pneumonia but centers around supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • supplemental oxygen
          • nasal suctioning
          • hydration
    • Medical
      • single dose of steroids
        • indication
          • croup
      • nebulized epinephrine
        • indications
          • croup
  • Complications
    • Respiratory failure
    • Pneumonia
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