Adult Croup: A Rare but More Severe Condition

Abstract

We report the first adult patient with virologically confirmed croup caused by parainfluenza virus type 3 and review 10 cases of adult croup described in the English-language literature. Circumstantial evidence of viral infection was present in only 1 other case, in which there was a rise in antibody titer against influenza B virus. Ten patients (91%) required intensive care support. None of the 11 patients died. A comparison was also made between the 11 adults with croup and 43 children hospitalized with severe croup described in a representative paper published in 1984. Adult croup represents an apparently more severe disease entity than pediatric croup.

Parainfluenza Viruses

“…Even during HPIV-1-epidemic years, HPIV-2 has been reported to cause Ͼ60% of the croup cases in an individual community (232). HPIV-3 has been demonstrated to cause severe croup in an adult (386). RSV, influenza A and B viruses, adenoviruses, rhinoviruses, and, in school age children, Mycoplasma have all been shown to cause croup.…”

Clinical and Molecular Epidemiology of Human Parainfluenza Virus 4 Infections in Hong Kong: Subtype 4B as Common as Subtype 4A

“…These 35 NPAs were from 34 patients, with 1 patient (case no. 19) having two NPAs positive during the same admission (Table 1). Fifteen (44%) patients had underlying diseases.…”

“…Although human parainfluenza viruses (HPIVs) are often associated with upper respiratory tract infections, they are also increasingly implicated in more severe disease, especially in immunocompromised patients (5,15,19). Based on genotypic and antigenic characteristics, four HPIV serotypes (HPIV1 to -4) are recognized.…”

A case of adult croup

“…One of these required intubation while the other did not [3,4]. Table 1 summarizes the clinical features of these 12 cases.…”

“…One throat culture in Deeb's initial case series did yield H. influenza (type B) [1]. Woo et al isolated parainfluenza virus type 3 from their patient [3], and secondary evidence of Influenza B was found in one patient from Tong et al [2]. Generally, the organisms responsible for pediatric croup are uncommon in the adult population.…”