INFECTIOUS CROUP: III. HEMOPHILUS INFLUENZAE TYPE B CROUP

Croup due to H. influenzae type B occurred in 8% of a group of 347 cases of infectious croup. Bacteriologically and pathologically the disease was distinct from diphtheritic and so-called "virus" croup. Clinically this form of croup is characterized by the extreme rapidity of onset and the severity of symptoms. The outstanding clinical signs and symptoms encountered were: severe sore throat, epiglottitis with supraglottic edema, extreme early prostration, marked leukocytosis with a high polynudear percentage, tender anterior cervical adenitis, and necessity for very early tracheotomy in selected cases. Treatment consists of two important parts: relief of respiratory obstruction and treatment of the accompanying bacteremia and toxemia. The former calls for early tracheotomy to avoid the frequent adverse results of thoracic extra-alveolar air; intubation is contraindicated. Treatment of the second problem calls for transfusions of whole blood plus early administration of type-specific rabbit antiserum and sulfadiazine and streptomycin in high dosage. Death from H. influenzae type B croup is attributed to bacteremia and toxemia, aided by progressive respiratory tract obstruction.