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Zoorob, R., Sidani, M. A., & Murray, J. (2011). Croup: An overview. American Family Physician, 83(9), 1067–1073. Retrieved from Reply 2Monica,
I completely agree with your diagnosis, but also wanted to present an argument for an additional consideration. Because this child may not have completed the DTaP vaccine series, he may be at an increased risk for pertussis. Many years ago I worked in a pediatric ER and learned not to disregard unusual presentations. When you hear a barking cough,you think croup and expect pertussis to exhibit the usual “whooping” sound between breaths. But, that is not always thecase. I saw a child in the ER who was coughing and making a high-pitched sound on inspiration (sounding much like the classic whoop). In this case, it was a foreign body aspiration, not pertussis. It is important the provider look at all possibledifferential and complete any needed evaluations to properly diagnose. In addition to the possibility of pertussis, Zoorob,Sidani, & Murray (2011) suggested the following differentials for croup: However, physicians should consider other diagnoses, including bacterial tracheitis, epiglottitis, foreign body aspiration, peritonsillar abscess, retropharyngeal abscess, and angioedema.Commonly caused by Bordetella pertussis, pertussis a highly contagious disease, often presents with mild upper respiratory symptoms initially followed by a cough that is paroxysmal in nature; many children over the age of 6-years-old may have less typical, more mild symptoms (Kline, Lewis, Smith, Tracy, & Moerschel, 2013). The bacteria attach and paralyze the cilia in the upper airways leading to inflammation. Brashers and Huether (2017) noted any cough serves as aprotective mechanism, in the case of pertussis, it is an attempt to clear the airway since the protective cilia are not functioning. Is testing needed to rule in your preferred differential? Is so, what?In these posts, each of us have identified possible causes for this child’s illness that may be related to the status of his immunizations. What information could you share with the parents to motivate them to complete needed vaccinations? What resources could you offer them in yourcommunity?ReferencesBrashers, V. L. & Huether, S. E. (2017). Alterations of pulmonary function. In S. E. Huether & K. L. McCance, (Eds.), Understanding pathophysiology(6th ed., pp. 687-714). St. Louis, MO: Mosby.Hammer, G. D., & McPhee, S. J. (2014). Pathophysiology of disease: An introduction to clinical medicine(7th ed.). New York, NY: McGraw-Hill Education.Hiemstra, P. S., McCray, P. B., & Bals, R. (2015). The innate immune function of airway epithelial cells in inflammatory lung disease. The European Respiratory Journal, 45(4), 1150–62. Karunanayake, C., Hagen, B., Dosman, J., & Pahwa, P. (2013). Prevalence of and Risk Factors for Self-Reported Chronic Bronchitis in a Canadian Population: The Canadian Community Health Survey, 2007 To 2008. Canadian Respiratory Journal, 20(4), 231–236. Kline, J. M., Lewis, W. D., Smith, E. A., Tracy, L. R., & Moerschel, S. K. (2013). Pertussis: a reemerging infection. American