Case study suggests connection of COVID-19 with croup among infants

Turkey: A research brief and a case report published in Pediatric Infectious Disease Journal have indicated a connection between croup and COVID-19 in infants.

Fever and cough are the most common symptoms of coronavirus disease 2019 (COVID-19) in children but croup cases associated with COVID-19 are reported in the literature and have increased sharply with the Omicron variant. Sevgi Dasdemir, Department of Pediatrics, Gazi University Hospital, Ankara, Turkey, and colleagues present severe acute respiratory syndrome coronavirus 2 as a viral agent in an infant presenting with croup.

Croup is a common viral infection associated with rhinovirus, parainfluenza, and respiratory syncytial virus infections and Human coronavirus NL63 (HCoV-NL63) and self-limiting illness that typically resolves within a few days. COVID-19, another coronavirus causing respiratory illness thereby could also cause croup. 

Researchers described the case of a healthy 23-month-old child who suddenly had a fever and a "barking" cough, and was admitted to the hospital's PICU. Tests for rhinovirus, adenovirus, and influenza others came back negative, but a nose swab for SARS-CoV-2 was positive.

The patient was diagnosed with SARS-CoV-associated croup. The child was treated on the first day with 0.6 µmg/kg oral dexamethasone, inhaled adrenaline and had O2 saturation of 96% under 10L/min oxygen in a reservoir mask. 

Since stridor and tachypnea continued 10 hours after the first dose of dexamethasone, a second dose of 0.6mg/kg dexamethasone and inhaled adrenaline treatment was given the next day. Noisy breathing and tachypnea resolved after 24 hours.

Discharge of the patient was done on the 3rd day of stay and issues resolved by the 7th day. 

Our case had a mild course of SARS-CoV-associated croup treated with early isolation measures and was discharged after 3 days of treatment, the researchers noted. 

"We recommend that one of the causes of croup in children is COVID-19 and that COVID-19 should be added to the viral panel to determine the origin of croup," the researchers wrote. "We would also like to point out that COVID does not contribute to the severity of croup and may not be an indicator for complications such as [multi-system inflammatory syndrome in children]."

Reference:

Dasdemir, Sevgi MD*; Uysal Yazici, Mutlu MD†; Gudeloglu, Elif MD‡; Akkuzu, Emine MD†; Tezer, Hasan MD‡ CROUP AS A PREVIOUSLY UNRECOGNIZED SYMPTOM OF COVID-19 IN INFANTS, The Pediatric Infectious Disease Journal: April 22, 2022 - Volume - Issue - 10.1097/INF.0000000000003565 doi: 10.1097/INF.0000000000003565