Croup vs Epiglottitis and bacterial tracheitis
How to tell Croup and Epiglottitis and bacterial tracheitis apart when a board question makes them look alike.
Croup is barking cough/steeple; epiglottitis is drooling tripod/thumbprint; bacterial tracheitis is toxic purulent airway infection.
Side by side
Croup causes viral laryngotracheitis with barking cough, inspiratory stridor, low-grade fever, and steeple sign, often from parainfluenza.
Epiglottitis classically follows Hib or other bacterial infection with toxic drooling, tripod posture, muffled voice, and thumbprint sign; bacterial tracheitis often follows viral illness with Staphylococcus aureus, high fever, toxic appearance, and thick purulent secretions.
Croup causes viral laryngotracheitis with barking cough, inspiratory stridor, low-grade fever, and steeple sign, often from parainfluenza.
Epiglottitis is supraglottic bacterial inflammation with airway obstruction risk; suspected cases require airway control and avoidance of aggressive pharyngeal exam. Bacterial tracheitis is purulent bacterial infection below the glottis.
Watch it explained
Test it nowThe repair move
Before naming the answer, force the stem through the separator: Croup is barking cough/steeple; epiglottitis is drooling tripod/thumbprint; bacterial tracheitis is toxic purulent airway infection.
Try a free question
CoreA 2-year-old presents with 2 days of low-grade fever, mild rhinorrhea, a 'barking' (seal-like) cough, and inspiratory stridor that worsens with crying. He appears non-toxic and is not drooling. Lateral neck X-ray shows subglottic narrowing (steeple sign). Which condition is most likely?
Show answer and explanation
Answer: A. Viral croup (laryngotracheobronchitis). Viral croup (laryngotracheobronchitis) is the most common cause of pediatric stridor (6 months to 6 years). Parainfluenza virus type 1 is most common. Subglottic edema produces barking cough, inspiratory stridor, hoarseness, and 'steeple sign' (subglottic narrowing) on neck X-ray. Treat with humidified air, dexamethasone (single dose), and nebulized racemic epinephrine for moderate-severe disease.
Why the other choices are tempting
- B. Epiglottitis is toxic-appearing with drooling, tripod posture, muffled voice, and thumbprint sign on lateral neck X-ray (supraglottic obstruction); Hib historically the most common cause.
- C. Bacterial tracheitis is toxic with high fever, purulent secretions, and poor response to croup therapy; often Staph aureus.
- D. Foreign body aspiration is sudden onset with focal wheeze/diminished breath sounds.
- E. Retropharyngeal abscess shows retropharyngeal widening on X-ray with toxic appearance.
Flashcards
Tap a card to flip it.
What clue supports Croup?
Choose Croup when the stem gives this pattern: Croup causes viral laryngotracheitis with barking cough, inspiratory stridor, low-grade fever, and steeple sign, often from parainfluenza.
What clue supports Epiglottitis and bacterial tracheitis?
Choose Epiglottitis and bacterial tracheitis when the stem gives this contrasting pattern: Epiglottitis causes toxic drooling tripod posture and thumbprint sign; bacterial tracheitis causes high fever, toxic appearance, and thick purulent tracheal secretions.
Quick answers
What is the fastest way to tell Croup from Epiglottitis and bacterial tracheitis?
Croup is barking cough/steeple; epiglottitis is drooling tripod/thumbprint; bacterial tracheitis is toxic purulent airway infection.
What is the key clue for Croup?
Croup causes viral laryngotracheitis with barking cough, inspiratory stridor, low-grade fever, and steeple sign, often from parainfluenza.
What is the key clue for Epiglottitis and bacterial tracheitis?
Epiglottitis classically follows Hib or other bacterial infection with toxic drooling, tripod posture, muffled voice, and thumbprint sign; bacterial tracheitis often follows viral illness with Staphylococcus aureus, high fever, toxic appearance, and thick purulent secretions.