Croup

Abstract: ContextWhile hospitalization rates have declined overall, hospitalizations for acute lower respiratory tract infections have increased steadily since 1980 Development of new approaches for prevention of acute respiratory tract conditions requires studies of the etiologies of infections and quantification of the risk of hospitalization for vulnerable patientsObjectiveTo determine the frequency of specific virus infections associated with acute respiratory tract conditions leading to hospitalization of chronically ill patientsDesignAnalysis of viral etiology of patients hospitalized with acute respiratory tract conditions between July 1991 and June 1995SettingFour large clinics and related hospitals serving diverse populations representative of Harris County, TexasPatientsA total of 1029 patients who were hospitalized for pneumonia, tracheobronchitis, bronchiolitis, croup, exacerbations of asthma or chronic obstructive pulmonary disease, and/or congestive heart failureMain Outcome MeasureVirus infection, defined by culture, antigen detection, and significant rise in serum antibodies, by underlying condition; hospitalization rates by low- vs middle-income statusResultsNinety-three percent of patients older than 5 years had a chronic underlying condition; a chronic pulmonary condition was most common Patients with chronic pulmonary disease from low-income populations were hospitalized at a rate of 3986 per 10,000, almost 8 times higher than the rate for patients from middle-income groups (522 per 10,000; P<001) Of the 403 patients (444% of adults and 323% of children) who submitted convalescent serum specimens for antibody testing, respiratory tract virus infections were detected in 181 (449%) Influenza, parainfluenza, and respiratory syncytial virus (RSV) infections accounted for 75% of all virus infectionsConclusionsOur study suggests that respiratory virus infections commonly trigger serious acute respiratory conditions that result in hospitalization of patients with chronic underlying conditions, highlighting the need for development of effective vaccines for these viruses, especially for parainfluenza and RSV

Abstract: Recurrent respiratory papillomatosis (RRP), which is caused by human papillomavirus types 6 and 11, is the most common benign neoplasm of the larynx among children and the second most frequent cause of childhood hoarseness. After changes in voice, stridor is the second most common symptom, first inspiratory and then biphasic. Less common presenting symptoms include chronic cough, recurrent pneumonia, failure to thrive, dyspnea, dysphagia, or acute respiratory distress, especially in infants with an upper respiratory tract infection. Differential diagnoses include asthma, croup, allergies, vocal nodules, or bronchitis. Reports estimate the incidence of RRP in the United States at 4.3 per 100,000 children and 1.8 per 100,000 adults. Infection in children has been associated with vertical transmission during vaginal delivery from an infected mother. Younger age at diagnosis is associated with more aggressive disease and the need for more frequent surgical procedures to decrease the airway burden. When surgical therapy is needed more frequently than four times in 12 months or there is evidence of RRP outside the larynx, adjuvant medical therapy should be considered. Adjuvant therapies that have been investigated include dietary supplements, control of extra-esophageal reflux disease, potent antiviral and chemotherapeutic agents, and photodynamic therapies; although several have shown promise, none to date has "cured" RRP, and some may have serious side effects. Because RRP, although histologically benign, is so difficult to control and can cause severe morbidity and death, better therapies are needed. The potential for a quadrivalent human papilloma vaccine is being explored to reduce the incidence of this disease.

Abstract: Acute respiratory infections cause four and a half million deaths among children every year, the overwhelming majority occurring in developing countries. Pneumonia unassociated with measles causes 70% of these deaths; post-measles pneumania, 15%; pertussis, 10%; and bronchiolilitis and croup syndromes, 5%. Both bacterial and viral pathogens are responsible for these deaths. The most important bacterial agents are Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus

Abstract: Background The clinical relevance of infections with the novel human coronavirus NL63 (HCoV-NL63) has not been investigated systematically. We therefore determined its association with disease in young children with lower respiratory tract infection (LRTI).