Croup

What is croup?

Croup is a condition that develops quickly in children and is usually caused by a viral infection in the upper airways that is localised in the throat and surrounding tissues. It is characterised by a barking cough.
It usually occurs in young children under five years of age, and in most cases clears up spontaneously in 24 to 48 hours.
Very rarely, croup is a sign of something much more serious, such as diphtheria.
How do you get croup?

The virus can either be transferred through airborne droplets produced by coughing and sneezing, or passed from one person to another by touch. From the hands, the virus may enter the mucous membrane of the eyes and nose.
Croup is usually caused by the parainfluenza virus, although there are many other possible viral causes. These include the RS virus, influenza virus type A, rhinovirus, adenovirus, and Coxsackie virus.
If a child has had croup before, it tends to recur when they have a cold. After the age of four to five years, these symptoms decrease in severity.
There may be an allergic element connected to the parainfluenza virus.
What are the signs of croup?

• A characteristic rough, barking cough.
  
• Hoarseness and noisy breathing.
  
• The symptoms often occur at night when the child has been lying down for a couple of hours.
  
• Fever.
  

What should one be especially aware of?

• The child becoming more tired.
  
• Difficulty breathing.
  
• Blueness around the mouth, nose, and nails.
  

Seek urgent medical help if any of these problems occur.
What can you do yourself?

• Calm the child as much as possible.
  
• Keep calm yourself. Obvious signs of uneasiness and anxiety will upset the child.
  
• Sit the child up, which will allow them to breathe more easily.
  
• Inhaling steam may lessen the symptoms - to create steam, try sitting the child in the bathroom with the hot tap running.
  
• Avoid heavy meals, since coughing may provoke vomiting.
  
• Encourage the child to drink plenty of fluids.
  
• If the child has a fever they should wear as few clothes as possible and not be put under warm bedclothes.
  

How does the doctor make a diagnosis?

• The diagnosis is made on the basis of the symptoms of the disease.
  
• If the doctor wants to know which micro-organism has caused the disease, a swab from the throat can be taken for examination.
  
• An X-ray may be needed, but only if the child is ill enough to need hospital admission.
  

Future prospects
Croup usually clears up without a problem in three to four days. However, the coughing may last some time longer. The disease usually gets worse at night when the child is lying down.
Additional problems that may be caused by croup include:

• severe breathing problems and lack of oxygen.
  
• blocking of the airways (obstruction). This is rarely seen, but is life-threatening.
  

How is croup treated?
Since the disease is a viral infection it cannot be treated with antibiotics.
Serious cases of croup result in admission to hospital where the patient will be given oxygen, corticosteroids and adrenaline by inhalation-treatment

Chickenpox (varicella)

What is chickenpox?

Chickenpox is a highly contagious illness that is common in children. It causes an itching skin rash with blisters. The disease is caused by the varicella-zoster virus and usually runs its course without problems.
How do you catch chickenpox?
The viral infection is transferred from one person to another through direct contact with the broken chickenpox blisters and through airborne droplets.
The infectious period lasts from about three days before the rash appears until all the blisters have formed scabs.
The incubation period between being infected with chickenpox until the disease breaks out and symptoms appear is 10 to 20 days.
What are the symptoms of chickenpox?

• A rash that usually begins on the body and face and later often spreads to the scalp and limbs.
  
• It may also spread to the mucous membranes especially in the mouth and on the genitals.
  
• The rash is often itchy.
  
• It begins as small red spots which develop into blisters in a couple of hours.
  
• After one or two days, the blisters turn into scabs.
  
• New blisters may appear after three to six days.
  
• The number of blisters differs greatly from one person to another.
  
• The infected person may run a temperature.
  
• These symptoms are mild in young children.
  
• Chickenpox lasts 7 to 10 days in children and longer in adults.
  
• Adults can feel very ill and take longer to recover. They are also more likely than children to suffer complications.
  

Who is at risk of complications?

• Pregnant women who have not had chickenpox.
  
• People with a weak immune system, such as those with acute or chronic leukaemia or HIV.
  
• Patients taking medicine to suppress their immune system, such as long-term oral corticosteroids.
  

Those in the at-risk group who are exposed to the varicella-zoster virus can be given an injection of varicella-zoster-immunoglobin to boost their immunity. In some countries, vaccination against chickenpox is available.
How does the doctor make a diagnosis?
The diagnosis is made by observing the symptoms and the typical appearance of the rash.
How is chickenpox treated?

• The treatment mostly consists of easing the symptoms.
  
• Remember that an infected person will be contagious until new blisters have stopped appearing and until all the blisters have scabs. They should stay at home while they are infectious.
  
• Avoid scratching the blisters because of the risk of infection.
  
• Cut the nails short or make the patient wear gloves.
  
• Pay attention to personal hygiene.
  
• Calamine lotion will help to relieve the itching.
  
• Keep the patient in cold surroundings, as heat and sweat may make the itching worse.
  
• In attacks of chickenpox where the itching is so serious that the child's sleep is totally disturbed, antihistamine medicines with a heavily sedative effect can be used. Antihistamines are medicines for allergic reactions, motion sickness or insomnia .
  
• In serious cases of chickenpox in people with a weak immune system, aciclovir (eg Zovirax tablets/suspension), which works specifically against chickenpox, can be used.
  

Which complications might arise?

• Bacteria may infect the blisters.
  
• Occasionally scars may remain at the site of the blisters.
  
• Conjunctivitis.
  
• Pneumonia.
  
• In very rare cases, chickenpox can result in complications such as meningitis, encephalitis, inflammation of the heart (myocarditis) or Reye's syndrome.
  

Future prospects
Once a person has had chickenpox, they will have immunity to the disease for the rest of their life. However, the virus may return later in life as shingles.
A person who has active shingles can infect others with chickenpox, but cannot give shingles to someone else.