Croup is a respiratory infection most commonly observed in children, characterized by swelling inside the trachea, or windpipe. This swelling obstructs normal breathing, leading to a distinctive “barking” cough, often described as resembling the sound of a seal. Hoarseness and noisy breathing, known as stridor, may also accompany the cough. Fever and a runny nose can also be present as initial symptoms.
Adult Susceptibility and Symptoms
While croup is predominantly a childhood illness, adults can contract it, though it is rare. The primary reason croup is less frequent in adults is due to their larger and more developed airways. A small amount of swelling in a child’s narrower windpipe can significantly impede breathing, whereas adults’ broader airways are less susceptible to such obstruction. When adults do develop croup, the symptoms can be more severe, potentially requiring more aggressive treatment and even hospitalization.
Adult croup symptoms often begin with cold-like signs such as a runny nose, sore throat, and fever. As the infection progresses, adults may experience a hoarse, barking cough, along with voice changes or loss. Stridor can also occur, and adults might report trouble breathing or shortness of breath. Hoarseness might be more prominent in adults, and symptoms can worsen at night.
Causes, Transmission, and Prevention
Croup is primarily caused by viral infections. The most common culprits are parainfluenza viruses, particularly types 1 and 2, which account for about 75% of cases. Other viruses that can lead to croup include influenza A and B, respiratory syncytial virus (RSV), adenovirus, and measles. Rarely, bacterial infections can also be a cause.
These viruses spread from person to person through respiratory droplets. When an infected individual coughs or sneezes, they release virus-containing droplets into the air, which can then be inhaled by others. Transmission can also occur through indirect contact, where a person touches a contaminated surface or object and then touches their eyes, nose, or mouth. Viruses like parainfluenza can remain infectious on surfaces for several hours, and RSV can survive for hours on hard surfaces.
Individuals are contagious from about one day before symptoms appear until 7-10 days after symptom onset for parainfluenza, and 3-8 days for RSV, sometimes longer in immunocompromised individuals. Preventing the spread involves practicing good hand hygiene, such as frequent and thorough handwashing. Avoiding close contact with sick individuals and refraining from sharing cups and utensils can also help. Staying home when ill and encouraging coughing and sneezing into an elbow or a tissue are effective preventive measures.
Diagnosis and Management
Diagnosing croup in adults involves a clinical evaluation based on presenting symptoms, especially the characteristic barking cough, hoarseness, and stridor. A healthcare provider will inquire about the patient’s medical history and current symptoms. While a physical examination helps, the diagnosis is primarily clinical, focusing on the distinct sound of the cough and breathing. In some instances, a chest X-ray might be performed to rule out other conditions.
Management strategies for adult croup focus on supportive care to alleviate symptoms. This includes using humidifiers to moisten the air, which can help ease breathing and coughing. Staying well-hydrated by drinking plenty of fluids and getting adequate rest are recommended to support the body’s recovery. Over-the-counter pain relievers can be used to manage fever and discomfort.
Medical interventions for adult croup may include steroids, such as dexamethasone, administered orally, intravenously, or via injection, to reduce airway swelling. In more severe cases, inhaled epinephrine may be used to temporarily relieve swelling in the airways. Supplemental oxygen might also be necessary if breathing difficulties are significant. Seeking medical attention is advisable if symptoms are severe, if there is significant difficulty breathing, or if symptoms persist or worsen.