CASE 2
The patient was a 1-year-old male who was brought to the clinic in January because he developed fever, chest congestion, rhinorrhea, decreased oral intake and a "barking" cough 3 days previously.
His medical history was significant only for recurrent otitis media. On examination, his temperature was 38.40C. He was in no acute distress and had audible obstructive upper airway sounds. His throat was erythematous. On lung examination, upper airway sounds were prominent and there was no wheezing or subcostal retractions. The clinical impression was that he had croup. Specimens were sent for viral cultures. He was managed with therapies for symptomatic relief including the use of a humidifier in the home. Ten days later parainfluenza was identified from a nasopharyngeal specimen only after hemadsorption studies were done on the virus culture.
BACKGROUND
This patient's clinical diagnosis was croup (acute laryngotracheobronchitis).
This patient was infected with parainfluenza virus type 1 (PIV-1). PIV is the virus most commonly associated with croup. There are four serotypes of PIV, PIV-1 to PIV-4. Like influenza virus, PIV produces both hemagglutinins and neuraminidase. Unlike influenza virus, PIV has a nonsegmented genome and the four types are antigenically stable. RSV can cause a similar clinical syndrome to PIV.
Case 2
How is the virus transmitted?
What is croup? Why don’t adults get
croup?
Describe how the clinical diagnosis of
croup was confirmed. Is laboratory confirmation critical in all cases?
Is this child likely to be re-infected?
What is the common symptom in adults with this infections?
If this child had more severe croup, what treatment would be appropriate?