Venn, April MR, James M. Schmidt, and Paul C. Mullan. “A case series of pediatric croup with COVID-19.” The American journal of emergency medicine (2020).

A case series of pediatric croup with COVID-19

Abstract

We describe three previously healthy children, admitted from our emergency department (ED) to our free-standing children’s hospital, as the first documented cases of croup as a manifestation of SARS-CoV-2 infection. All three cases (ages 11 months, 2 years, and 9 years old) presented with non-specific upper-respiratory-tract symptoms that developed into a barky cough with associated stridor at rest and respiratory distress. All were diagnosed with SARS-CoV-2 by polymerase chain reaction testing from nasopharyngeal samples that were negative for all other pathogens including the most common etiologies for croup. Each received multiple (≥3) doses of nebulized racemic epinephrine with minimal to no improvement shortly after medication. All had a prolonged period of time from ED presentation until the resolution of their stridor at rest (13, 19, and 21 h). All received dexamethasone early in their ED treatment and all were admitted. All three received at least one additional dose of dexamethasone, an atypical treatment occurrence in our hospital, due to each patient’s prolonged duration of symptoms. One child required heliox therapy and admission to intensive care. All patients were eventually discharged. Pathogen testing is usually not indicated in croup, but with “COVID-19 croup,” SARS-CoV-2 testing should be considered given the prognostic significance and prolonged quarantine implications. Our limited experience with this newly described COVID-19 croup condition suggests that cases can present with significant pathology and might not improve as rapidly as those with typical croup.

Summary: 

This article is a case series which assesses whether there is an association between pediatric Croup and Covid-19. I found this article very relevant and fascinating since at the outpatient clinic where I am currently rotating, there has been an uprise in croup cases this season, more than ever before. This article looks at 3 previously healthy children who were admitted from the emergency department to the children hospital, as the first documented cases of Covid-19 manifesting as croup in children. All 3 presented with general upper respiratory symptoms which developed into a barking cough along with stridor and respiratory distress , a classic manifestation of croup. In all 3, their Covid PCR tests came back positive, and tests for other pathogens more typically associated with croup came back negative. Pathogen testing is usually not indicated for croup, but it is now with “Covid-19 croup” in order to determine this specific etiology, so that patients and families can be counsel about isolation procedures. Based on their limited experience, researchers in this article explain that croup caused by Covid-19 could take longer to improve and present with greater pathological issues than in typical croup. 

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