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26

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Microbiology

Pathogens

Question 54 of 180

A 3 year old child is brought into ED with fever, a barking cough and difficulty breathing. On examination you note inspiratory stridor, tachypnoea and intercostal recession. Which of the following pathogens is the most likely infectious agent:

Answer:

The patient most likely has croup characterised by a barking cough, stridor and respiratory distress. Parainfluenza virus is the most commonly implicated infectious agent in croup.

Parainfluenza

Microbiology / Pathogens / Respiratory Viruses

Last Updated: 21st April 2019

Epidemiology

Parainfluenza virus infection, spread via the respiratory droplet route, peaks in winter, with the highest rates occurring in children less than 3 years old. The incubation period is about 2 - 6 days.

Clinical Features

It is a common, self-limiting condition which usually lasts about 4 - 5 days, during which children are distressed, coryzal and febrile.

It is the most common cause of croup (laryngotracheobronchitis). Croup occurs most commonly in children aged 6 months to 6 years. Croup is characterised by a barking cough, inspiratory stridor, hoarse voice and respiratory distress due to upper airway obstruction.

Rarely bronchiolitis, bronchopneumonia or acute epiglottitis may develop, signalled by reduced air entry and cyanosis.

Diagnosis

Diagnosis is clinical. Laboratory diagnosis can be made with direct immunofluorescence or NAAT detection.

Treatment

Treatment is supportive. More severe croup may require oral dexamethasone/prednisolone or nebulised adrenaline.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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