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Abstract
Purpose
In this study, the clinical and epidemiological characteristics of patients admitted for viral croup were analyzed to evaluate disease severity based on the organism that caused the infection.
Methods
We retrospectively reviewed the medical records of 302 patients who were admitted to the Department of Pediatrics at the Wonju Severance Hospital between May 2013 and December 2016 for viral croup. Patients who showed positive results on multiplex polymerase chain reaction were subsequently diagnosed with respiratory virus infection. The Westley scoring system was used to evaluate the severity of viral croup.
Results
Of the 302 patients, 149 were admitted due to severe viral croup, including 88 boys and 61 girls, with a boy-to-girl ratio of 1.44:1. About 110 cases of parainfluenza virus infection have been reported, which accounted for almost half of the total cases. The other identified viruses included influenza virus, human rhinovirus, and respiratory syncytial virus. Analysis of the association between severe viral croup and causative pathogen revealed that only parainfluenza type 2 virus showed a significantly high risk. Parainfluenza type 2 virus did not show an age-based difference in frequency but showed relatively a higher frequency of infections during the summer and fall.
Conclusions
In this study, parainfluenza virus type 2 was the only virus associated with severe viral croup. To facilitate proper preventive management, treatment, and prognosis evaluation of viral croup, prospective and multicenter studies should assess the additional variables and the severity of the virus. Additionally, further studies should be conducted to assess age-dependent influences, as well as the regional and seasonal incidence of viral infection.
References
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Fig. 1.
Distribution of detected viruses in children with viral croup according to age: (A) 1 year or less, (B) 1 year, (C) 2 year, and (D) 3 year or more, Abbreviations: PIV, parainfluenza virus; RSV, respiratory syncytial virus; Flu, Influenza virus; hRV, human rhinovirus; hMPV, human metapneumovirus; NL63, human coronavirus NL63; OC43, human coronavirus OC43; ADV, adenovirus; hBoV, human bocavirus.
Fig. 2.
Distribution of detected viruses in children with viral croup according to seasons: (A) spring, (B) summer, (C) autumn, and (D) winter, Abbreviations: PIV, parainfluenza virus; RSV, respiratory syncytial virus; Flu, Influenza virus; hRV, human rhinovirus; hMPV, human metapneumovirus; NL63, human coronavirus NL63; OC43, human coronavirus OC43; ADV, adenovirus; hBoV, human bocavirus.
Table 1.
Clinical Scoring System to Grade the Severity of Croup∗
Table 2.
Identified Viral Agents in the Hospitalized Patient with Croup in Wonju City, Korea
Table 3.
The Distribution of Co-detection of Viruses in the Hospitalized Patient with Croup in Wonju City, Korea
Table 4.
Univariate and Multivariate Logistic Regression Analysis of Viral Agents of Severe Croup
| Virus | Severe | None severe | Crude OR (95% CI) | Adjusted OR∗ (95% CI) |
|---|---|---|---|---|
| PIV-1 | 23 (20.35) | 32 (28.32) | 0.71 (0.38–1.31) | 0.72 (0.39–1.33) |
| PIV-2 | 12 (10.62) | 4 (3.54) | 3.50 (1.09–11.19) | 3.41 (1.06–10.98) |
| PIV-3 | 19 (16.81) | 20 (17.70) | 1.02 (0.51–2.04) | 1.08 (0.54–2.18) |
| RSV A | 5 (4.42) | 8 (7.08) | 0.66 (0.21–2.07) | 0.62 (0.19–1.98) |
| RSV B | 5 (4.42) | 5 (4.42) | 1.08 (0.30–3.83) | 1.11 (0.31–3.98) |
| Flu A | 7 (6.19) | 8 (7.08) | 0.94 (0.33–2.67) | 0.90 (0.31–2.60) |
| Flu B | 12 (10.62) | 8 (7.08) | 1.69 (0.66–4.30) | 1.63 (0.63–4.18) |
| hRV | 15 (13.27) | 12 (10.62) | 1.40 (0.62–3.13) | 1.38 (0.61–3.12) |
| hMPV | 4 (3.54) | 9 (7.96) | 0.46 (0.14–1.53) | 0.47 (0.14–1.59) |
| hCoV-NL63 | 5 (4.42) | 4 (3.54) | 0.85 (0.22–3.27) | 0.83 (0.21–3.20) |
| hCoV-OC43 | 3 (2.65) | 1 (0.88) | 0.35 (0.04–3.44) | 0.39 (0.04–-3.80) |
| ADV | 2 (1.77) | 1 (0.88) | 0.53 (0.05–5.96) | 0.53 (0.05–5.59) |
| hBoV | 1 (0.88) | 1 (0.88) | 1.07 (0.07–17.39) | 0.99 (0.06–16.28) |
Abbreviations: OR, odds ratio; CI, confidence interval; PIV, parainfluenza virus; RSV, respiratory syncytial virus; Flu, Influenza virus; hRV, human rhinovirus; hMPV, human metapneumovirus; hCoV, human coronavirus; NL63, human coronavirus NL63; OC43, human coronavirus OC43; ADV, adenovirus; hBoV, human bocavirus.
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