Comparison of etiology and clinical presentation between children with laryngotracheobronchopneumonitis and croup

Eun Jin Kim; Hyena Nam; Yong Han Sun; Hann Tchah; Eell Ryoo; Hye Kyung Cho; Hye Jung Cho; Dong Woo Son

doi:10.4168/aard.2017.5.5.274

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Kim, Nam, Sun, Tchah, Ryoo, Cho, Cho, and Son: Comparison of etiology and clinical presentation between children with laryngotracheobronchopneumonitis and croup

Original Article

Allergy Asthma Respir Dis 2017;5(5):274-279.

Published online: 5 September 2017

DOI: https://doi.org/10.4168/aard.2017.5.5.274

Comparison of etiology and clinical presentation between children with laryngotracheobronchopneumonitis and croup

Eun Jin Kim, Hyena Nam, Yong Han Sun, Hann Tchah, Eell Ryoo, Hye Kyung Cho, Hye Jung Cho, Dong Woo Son

Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea

Correspondence to: Yong Han Sun https://orcid.org/0000-0003-1527-6782 Department of Pediatrics, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-3224, Fax: +82-32-460-2362, E-mail: chdsyh@gilhospital.com

Received 6 April 201711 August 2017 Accepted 14 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Croup, a common childhood respiratory illness with various severities, has many unanswered questions. Laryngotracheobronchopneumonitis (LTBP) is a disease entity considered to be an extension of croup to the lower respiratory tract. The object of this study was to compare epidemiology, clinical characteristics, and viral etiologic spectrum between croup and LTBP.

Methods

Patients hospitalized with croup at Gachon University Gil Hospital from January 2010 to April 2016 were recruited. LTBP was defined as pneumonia confirmed on radiographs of patients with croup. Clinical findings and demographic data were reviewed of patients whose nasopharyngeal swabs were done for viral analysis.

Results

A total of 371 patients with only croup and 63 patients with LTBP were included. Croup was found to be significantly associated with parainfluenza virus type 1 (P=0.006). LTBP was related to parainfluenza virus type 3, respiratory syncytial virus, and human bocavirus (P=0.001, P=0.030, and P=0.019, respectively). The duration of fever was longer in patients with LTBP than in those with croup (3.87±1.85 days vs. 2.86±1.80 days, P<0.001).

Conclusion

Specific etiologic viruses might be associated with the progression from croup to LTBP. Pronged fever is also associated with progression from croup to LTBP.

Keywords: Croup, Extension, Pneumonia

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Fig. 1.

Distribution of etiologic agents of hospitalized pediatric patients with croup (A) and laryngotracheobronchopneumonitis (B).

Table 1.

Patient demographics

Variable	Croup (n=371)	LTBP (n=63)	P-value
Age (mo)	20.22±12.83	20.49±14.29	0.863
Male sex	225 (60.6)	39 (61.9)	0.483
Season
Spring	127 (34.2)	27 (42.9)	0.120
Summer	87 (23.3)	18 (28.6)	0.426
Autumn	78 (21.0)	9 (14.3)	0.239
Winter	79 (21.3)	9 (14.3)	0.237

Values are presented as mean±standard deviation or number (%). LTBP, laryngotracheobronchopneumonitis.

Table 2.

Clinical characteristics of the study subjects

Variable	Croup (n=371)	LTBP (n=63)	P-value
Fever	330 (88.9)	60 (95.2)	0.174
Barking cough	298 (80.3)	49 (77.8)	0.613
Respiratory difficulty	231 (62.4)	30 (47.6)	0.036∗
Voice change	259 (69.8)	42 (66.7)	0.657
Sputum	246 (66.3)	41 (65.1)	0.886
Rhinorrhea	241 (65.0)	44 (69.8)	0.477
Pharyngeal injection	235 (63.3)	34 (54.0)	0.163
Chest retraction	83 (22.4)	13 (20.6)	0.870
Wheezing	41 (11.1)	8 (12.7)	0.669
Crackle	35 (9.4)	12 (19.0)	0.029∗
Stridor	223 (60.1)	36 (57.1)	0.678

Values are presented as number (%).

LTBP, laryngotracheobronchopneumonitis.

^∗ P<0.05, statistically significant difference.

Table 3.

Laboratory findings of hospitalized pediatric patients with croup and LTBP

Variable	Croup (n=371)	LTBP (n=63)	P-value
WBC (×10³ cell/μL)	12.07±5.21	11.63±4.62	0.529
Neutrophil (%)	46.39±17.33	51.69±16.45	0.024∗
Lymphocyte (%)	41.32±16.08	36.79±14.72	0.037∗
Platelet (×10³ cells/μL)	280.60±92.21	292.71±93.01	0.336
CRP (mg/dL)	1.30±1.59	1.74±1.81	0.045∗
ESR (mm/hr)	14.37±11.30	18.42±15.14	0.146

Values are presented as mean±standard deviation.

LTBP, laryngotracheobronchopneumonitis; WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

^∗ P<0.05, statistically significant difference.

Table 4.

Clinical courses of hospitalized pediatric patients with croup and LTBP

Variable	Croup (n=371)	LTBP (n=63)	P-value
Duration of hospitalization (day)	4.36±1.42	5.29±1.90	<0.001∗
Total fever duration (day)	2.86±1.80	3.87±1.85	<0.001∗
High fever (≥39˚C)	204 (55.0)	40 (63.5)	0.220
O₂ supplementation	83 (22.4)	11 (17.5)	0.508
ICU admission (intubated)	1 (0.3)	1 (1.6)	0.268
Inhaled epinephrine	305 (82.2)	51 (81.0)	1.000
Antibiotics	220 (59.3)	40 (63.5)	0.580
Systemic steroid treatment	238 (64.2)	37 (58.7)	0.480

Values are presented as mean±standard deviation or number (%).

LTBP, laryngotracheobronchopneumonitis; ICU, intensive care unit.

^∗ P<0.05, statistically significant difference.

Table 5.

Etiologic agents in hospitalized pediatric patients with croup and LTBP

Virus	Odds ratio	95% CI	P-value
Parainfluenza virus type 1	0.31	0.13–0.73	0.006∗
Parainfluenza virus type 2	0.55	0.13–2.39	0.554
Parainfluenza virus type 3	4.69	2.07–10.67	0.001∗
Influenza virus	0.38	0.12–1.27	0.123
Human coronavirus	0.18	0.03–1.37	0.066
Respiratory syncytial virus	2.49	1.18–5.29	0.030∗
Human metapneumovirus	2.03	0.63–6.50	0.268
Human rhinovirus	0.41	0.05–3.18	0.707
Adenovirus	1.07	0.23–4.96	0.586
Human bocavirus	4.48	1.38–14.59	0.019∗
Mixed	1.11	0.60–2.02	0.755

CI, confidence interval; LTBP, laryngotracheobronchopneumonitis.

^∗ P<0.05, statistically significant difference.

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