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A research review and case report published last month suggest a link between croup and COVID-19 in infants.
Croup, one of a number of commonly treated pediatric infections that have resurfaced this past winter and are caused by human parainfluenza viruses (HPIVs), is characterized by an upper respiratory tract infection that causes a hard, repetitive cough as a result of swelling around the larynx causes trachea and bronchi.
The case report, published last month in the Journal of Pediatric Infectious Diseases and written by researchers at Gazi University Hospital in Turkey, discussed a healthy 23-month-old who suddenly developed a fever and a “barking” cough and was admitted to the hospital’s PICU. Tests for adenovirus, rhinovirus, influenza and others came back negative, but a nasal swab for SARS-CoV-2 was positive.
“The patient was diagnosed with SARS-CoV-associated croup and was treated on day one with 0.6 µmg/kg oral dexamethasone, inhaled adrenaline and O2 96% saturation under 10 L/min oxygen in a reservoir mask,” they wrote. “Since stridor and tachypnea persisted 10 hours after the first dexamethasone dose, a second dose of 0.6 mg/kg dexamethasone and inhaled epinephrine was administered the next day. Loud breathing and tachypnea resolved after 24 hours.”
The patient was discharged on day 3 of the stay, the researchers said, and problems were resolved by day 7.
“We recommend that one of the causes of croup in children is COVID-19 and that COVID-19 should be added to the viral panel to determine the origin of croup,” they wrote. “We would also like to note that COVID does not contribute to the severity of croup and may not be an indicator of complications such as: [multi-system inflammatory syndrome in children].”
The Research Brief, published in paediatrics and authored by researchers in the departments of general pediatrics at both Boston Children’s Hospital and Boston Medical Center, studied children diagnosed with COVID-19 who had a case of laryngotracheitis between March 1, 2020 and January 15, 2022 had
They found that 75 children were diagnosed with croup associated with COVID-19, with 81% of cases occurring during Omicron variant dominance and a sharp spike in December 2021. The median length of hospital stay was 1.7 days, during which time patients received dexamethasone and/or racemic epinephrine. The researchers also hypothesized that “the omicron variant causes laryngotracheobronchitis.”
“Two years after the COVID-19 pandemic, the pathogenicity, infectivity, and manifestations of new variants of SARS-CoV-2 were dynamic and unique,” they wrote. “Croup could represent another such novel presentation. Further research is needed to characterize the underlying mechanisms of COVID-19-associated croup, differences in clinical features from other viral etiologies, and appropriate treatment strategies in the SARS-CoV-2 era.”
Brewster R et al. paediatrics. 2022;doi:10.1542/peds.2022-056492.
Dasdemir S, et al. Pediatr Infect Dis J. 2021;doi:10.1097/INF.0000000000003565.