Croup syndrome in children: five-year experience.

To investigate the etiology and clinical features of croup syndrome, clinical records of hospitalized children with a diagnosis of croup syndrome were reviewed from April 1990 to January 1996. There was a total of 132 children, aged between three months and seven years with a mean age of 21.3 +/- 16.8 months. A diagnosis of laryngotracheobronchitis was made in 123 (93.2 percent) children. Twenty-three pathogens were identified in twenty-two of them, including seven parainfluenza viruses, five respiratory syncytial viruses, four influenza A viruses, four Mycoplasma pneumoniae, and three adenoviruses. Bacterial tracheitis was confirmed by bronchoscopic examination in seven cases (5.3 percent). Cultures of the respiratory secretions yielded viridans streptococci in six and Staphylococcus aureus in one child. Two children (1.5 percent) had spasmodic croup. No case with epiglottitis was noted in the present study. A fever lasting for more than three days was noted in five (71 percent) children with bacterial tracheitis and thirty-five (28 percent) children with laryngotracheobronchitis (p = 0.048). Among children with laryngotracheobronchitis, an associated diagnosis of pneumonia, acute otitis media, or paranasal sinusitis was more frequently observed in those with fever > 3 days (40 percent) than those with a shorter duration of fever (17 percent, p = 0.013). In conclusion, a child with a longer duration of fever and more severe manifestations of airway obstruction probably has a bacterial cause of croup syndrome or a bacterial complication. Bacterial tracheitis is more common than epiglottitis in Taiwan.