PEDIATRIC ID QUIZ

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PEDIATRIC ID QUIZ 3
ENLARGE IMAGE

• CC/HPI An 11 month old male presented
  during late September with history of rinorrhea
  for two days. He had been afebrile his oral
  intake was decreased since one day prior to his
  evaluation. He had a barky cough for one day.
  He was being evaluated because of persistent
  stridor and irritability
• Past medical history he had three upper
  respiratory infections since birth and an episode
  of otitis media.
• Family history he was exposed to an adult
  with an upper respiratory infection one week
  prior to this evaluation.
• Immunizations up to date
• Social He attends day care four days a
  week.

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ADDITIONAL INFORMATION
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WHICH INFORMATION WOULD YOU LIKE TO OBTAIN?
VITAL SIGNS
NECK AUSCULTATION
GENERAL
HEART
ABDOMEN
LUNGS
CHEST X-RAY
OXYGEN SATURATION
NECK X-RAY
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DIAGNOSIS
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WHICH ORGANISM IS THE MOST LIKELY ETIOLOGY OF
THIS PATIENTS CONDITION?
Parvovirus
Epstein-Barr virus
Calicivirus
Parainfluenza virus
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PARAINFLUENZA VIRUS
The patient presented here had signs and
symptoms of an upper respiratory infection
presenting during the month of September. Later
he developed significant stridor associated to
costal retractions suggestive of acute
laryngotracheitis (croup). The chest x-ray showed
normal lung parenchyma but the x-ray of his neck
showed findings consistent with narrowing of the
trachea (church steeple sign) also consistent
with acute laryngotracheitis. The most common
cause of acute laryngotracheitis is infection
with parainfluenza virus which occurs more
commonly during early fall. Parainfluenza virus
can also be the cause of bronchiolitis and
pneumonia. The diagnosis is confirmed by viral
culture of nasopharyngeal secretions on media
containing monkey kidney or embryonic kidney cell
lines. Episodes of laryngotracheitis caused by
parainfluenza viruses are usually self limited.
Patients who develop significant respiratory
distress may have to be hospitalized to be
treated and monitored for airway obstruction or
associated respiratory failure. In addition,
treatment with intravenous or oral steroids has
also been proven to be beneficial in decreasing
airway edema in severe cases. At present there is
not an antiviral agent approved for the treatment
of infections with parainfluenza viruses.
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Steeple sign (click here to enlarge)
Normal lung parenchyma (click here to enlarge)
Stridor (click here to listen)
ENLARGE IMAGE
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REFERENCES
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REFERENCES

• King L.Croup or laryngotracheobronchitis.
  eMedicine 2004. View reference
• Cetinkaya F, Tufekci BS, Kutluk G. A comparison
  of nebulized budesonide, and intramuscular, and
  oral dexamethasone for treatment of croup. Int J
  Pediatr Otorhinolaryngol. 2004 Apr68(4)453-6View
  reference
• Marx A, Torok TJ, Holman RC, Clarke MJ, Anderson
  LJ Pediatric hospitalizations for croup
  (laryngotracheobronchitis) biennial increases
  associated with human parainfluenza virus 1
  epidemics.J Infect Dis. 1997 Dec176(6)1423-7.
  View reference

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  completed this activity
• Check your e-mail frequently for Pediatric ID
  QUIZ
• If you have any questions about this or any
  other cases feel free to contact me by e-mail at
  bestrada_at_usouthal.edu or you may page me at
• 582-0072
• This activity has been supported by the
  Mitchell Clinical Scholars Program
• Benjamin Estrada MD
• Associate Professor of Pediatrics
• Division of Pediatric Infectious Diseases
• University of South Alabama