Barking cough in a child with fever

When a barking cough appears in a child with a fever, which is especially common with children in the first years of life, doctors strongly recommend that parents immediately seek medical help - to avoid serious consequences.

Causes of a barking cough in a child with a fever.

As clinical practice shows, the main causes of a barking cough in a child with a fever include the infectious disease whooping cough and an acute form of inflammation of the larynx - laryngitis.

Whooping cough affects the respiratory tract mainly in children, and attacks of spasmodic barking cough with this disease begin approximately 7-10 days after infection. Its pathogenesis is due to the colonization of the ciliated epithelium lining the respiratory tract mucosa by aerobic coccobacteria Bordetella pertussis. The pathogenic microorganism secretes several types of toxins that paralyze the epithelial cilia and cause inflammation of the mucosa.

In addition, enzymatically active bacterial cytotoxins bind to the membrane receptors of epithelial cells and disrupt the intracellular interaction of G proteins, increasing the irritability of the endings of epithelial nerve cells - cough irritant and C receptors. As a result, the cough center of the medulla oblongata receives afferent signals from irritated receptors more often than usual, which potentiates the cough reflex in whooping cough. In this case, irritation can affect the functions of other nuclei of the vagus nerve in the medulla oblongata, in particular, the vomiting, respiratory and vasomotor.

Due to age-related anatomical features of the respiratory tract in children under two years of age, the inflammatory process in laryngitis spreads to the trachea and bronchi. A spontaneously occurring condition, accompanied by a barking cough, hyperthermia and other symptoms, is diagnosed by pediatricians as acute stenotic (narrowing the lumen) laryngotracheitis or false croup.

Acute laryngotracheitis is caused by influenza orthomyxoviruses, parainfluenza virus Respirovirus Paramyxoviridae (causing almost a third of all cases of acute respiratory viral infections); adenovirus infection; respiratory syncytial virus of the Pneumoviridae family (HRSV). The development of pathology is possible with such viral diseases as chickenpox (caused by the herpesvirus Varicella Zoster) and measles, caused by the paramyxovirus Measles virus. Microbial etiology of false croup is also possible - with infection of the mucous membrane of the respiratory tract with bacteria Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae.

The pathogenesis of false croup is associated with inflammatory hypersecretion of mucin and an increase in the amount of mucous secretion that accumulates in the lumen of the larynx, which causes irritation of the reflexogenic zones of the mucous epithelium of the larynx and provokes a reflex spasm of its muscles.

Risk factors

The main risk factors for contracting whooping cough are the lack of DPT vaccination in children and contact with sick people. And the risk of developing false croup in young children (mostly in boys) is associated with weakened immunity, birth injuries, excess body weight of the child, as well as congenital anomalies of the respiratory tract or a genetic predisposition to allergies.

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Symptoms of a barking cough in a child with a fever.

The first signs of a barking cough in a child with a fever due to whooping cough appear only after the catarrhal stage of the disease (which is not much different from a common cold and can last for two weeks).

At the paroxysmal (convulsive or spasmodic) stage of whooping cough, the symptoms of a barking cough in a child with a temperature (subfebrile) - spontaneously occurring coughing spasms - are accompanied by a sharp whistling breath (stridor) and subsequent multiple non-stop coughing points (for one minute or more). During coughing, the tongue is stuck out of the mouth; due to the narrowing of the glottis, each cough push is accompanied by a sound reminiscent of a muffled bark of a dog. As they say, the child coughs until vomiting - 20 or more times a day.

Characteristic features include blueness (cyanosis) of the perioral area and the entire face, or redness (hyperemia) of the face; significant swelling of the soft tissues of the face; from the strain of coughing, the venous vessels in the neck and temples swell, and the capillaries of the eyeballs may burst (leading to hemorrhages). The cough is dry, although coughing up a small amount of viscous sputum at the end of each attack is possible. When listening to the lungs, wheezing (wet or dry) may be present.

In infancy, children may turn blue and red, gasp for air, and often experience apnea – a short-term cessation of breathing.

It is necessary to note such symptoms of dehydration in this disease as increased thirst and dry mouth, decreased diuresis, lethargy, tearless crying.

The spasmodic stage of whooping cough can last up to three months with a gradual decrease in the number of coughing attacks and their intensity.

With false croup, the following symptoms of a barking cough are observed in a child with a temperature (up to +38-38.5°C):

• nightly coughing fits with suffocation;
• hoarse, muffled voice;
• shallow breathing, difficulty breathing, with shortness of breath;
• breathing is stridor (wheezing when inhaling), and when mucous secretions accumulate, it is gurgling;
• difficulty swallowing;
• cyanosis of the skin in the mouth area;
• swelling of the cervical lymph nodes.

Depending on the degree of laryngeal narrowing – compensated, subcompensated, decompensated or terminal – the restless behavior of a sick child with an increased pulse and shortness of breath turns into a state of inhibition, in which the heart rate is unstable (with periods of bradycardia), the chest collapses during inhalation (bulging during exhalation), and breathing becomes shallow. The terminal stage, which threatens the child’s life, develops very quickly and is manifested by severe laryngeal edema, signs of suffocation, weakening of the pulse, diffuse cyanosis of the skin (indicating total hypoxia), and loss of consciousness.

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Complications and consequences

In whooping cough, the consequences and complications of barking cough include the development of bronchitis, bronchiolitis, pneumonia, bronchopneumonia; the appearance of hemorrhages under the conjunctiva of the eyes; rupture of the sublingual frenulum (due to protruding tongue during severe coughing). There may be complications such as collapse of the walls of the pulmonary segments (atelectasis), right-sided enlargement of the heart (due to pulmonary hypertension). Encephalopathy occurs due to partial paralysis of the cranial nerves.

Acute heart failure and asphyxia in whooping cough are the cause of respiratory arrest and death in infants and children under one year of age (in 1-2% of cases). In such situations, endotracheal intubation or intensive therapy with artificial ventilation of the lungs should be performed. That is why, with any intensity of barking cough in a child with a fever, treatment should be carried out in a hospital setting.

Consequences and complications of acute stenosing laryngotracheitis: dehydration, laryngeal stenosis and asphyxia; nosebleeds and ear bleeding; perforation of the eardrum; convulsions; inguinal or umbilical hernias; rectal prolapse (prolapse of the rectum); secondary microbial pneumonia, bronchopneumonia, otitis.

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Diagnostics of a barking cough in a child with a fever.

Since a barking cough in a child with a fever is a symptom, diagnostics must determine its specific cause.

For this – in addition to examining the child’s throat, auscultating his lungs and assessing the clinical picture – the following tests are needed:

• general blood test;
• throat culture (smear from the mucous membrane of the pharynx) or examination of a sputum sample for pathogenic microflora (including strepto- and staphylococci);
• serological analysis of a nasopharyngeal swab (to detect B. pertussis);
• enzyme immunoassay of blood (for specific antibodies);
• PCR blood test.

Instrumental diagnostics: laryngoscopy and chest X-ray.

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Differential diagnosis

Against the background of catarrhal symptoms, differential diagnostics is designed to identify whooping cough or laryngotracheitis and not to confuse them with ARVI or other respiratory diseases, for example, acute bronchitis or epiglottitis. Or not to miss the presence of a foreign body in the respiratory tract.

Treatment of a barking cough in a child with a fever.

Etiological treatment of barking cough in a child with fever and whooping cough is based on the use of antibacterial drugs of the macrolide group, active against Bordetella pertussis:

Erythromycin - at the rate of 20-40 mg per kilogram of the child's body weight per day (the daily dose is divided into 4 doses); duration of use - two weeks;

Azithromycin syrup (Sumamed) – daily dose – 10 mg/kg, once a day for five days.

It is believed that the use of antibiotics is appropriate only in the initial stage of whooping cough, but the possible complication of the disease by the addition of a secondary infection forces most domestic infectious disease specialists to play it safe and use these drugs at a later stage - when a barking cough appears.

It should be borne in mind that the room where the sick child is located must have high humidity, this helps to improve the child's condition and reduce the frequency of coughing fits. To do this, you can fill the bathtub with hot water - so that as much steam as possible is formed, and take the child into the bathroom for 10-15 minutes.

You should not lay the child down; it is better to keep him in an upright or semi-sitting position.

It is necessary to give the child water as often as possible to prevent dehydration and thin the mucus.

In case of whooping cough, such methods of treating a cold cough as mustard plasters, hot foot baths, rubbing the chest with ointments, and using cups are absolutely contraindicated.

For children under two years of age, drugs in the form of a spray are not prescribed, as their use can cause laryngeal spasm and suffocation.

In the treatment of barking cough in a child with false croup, antibiotics can be prescribed only if a microbial infection is detected. In case of viral origin of the pathology, the following medications are used:

• glucocorticoids Prednisolone, Dexamethasone - 0.25-0.5 mg per day (orally or parenterally);
• antihistamines (Tavegil, Cetirizine, Suprastin, Fenistil) – to reduce swelling of the mucous membrane of the respiratory tract;

For cough, medications that act on the cough center of the brain can be prescribed. Broncholitin syrup (Bronchoton) with glaucine hydrochloride and ephedrine is allowed to be used only after three years - one teaspoon three times a day. The drug can cause nausea and dizziness.

Tusuprex (Oxeladin, Neobex, Paxeladin, Pectussil, Tussimol and other trade names) is given to children under 12 months at 5 mg (grind half a 0.01 g tablet into powder and mix with water) three times a day, after one year - 5-10 mg. Temporary digestive problems are possible as a side effect.

Carbocisteine (Mukosol, Mukolik, Mukodin, Fluditec, etc.) is an expectorant, mucolytic and respiratory function stimulating syrup. Children under five years of age are recommended to take half a teaspoon up to three times a day. Contraindications for this drug include acute forms of cystitis and glomerulonephritis, and its possible side effects include skin rash, headache, nausea, diarrhea and gastrointestinal bleeding.

Folk treatment for a barking cough in a child with a fever involves five-minute soda inhalations (a teaspoon of baking soda per 250 ml of boiling water) or inhalations of alkaline mineral water (sprayed into the throat and larynx from an inhaler).

Physiotherapy treatment also includes oxygen therapy (used in severe cases of whooping cough).

And surgical treatment for critical narrowing of the pharyngeal lumen involves intubation of the trachea with the insertion of an endotracheal tube, and in the case of suffocation at the decompensated or terminal stage of false croup, performing a tracheotomy with the installation of a breathing tube.

Prevention

Currently, the main prevention of whooping cough infection in children consists of timely vaccination with the DPT vaccine.

And prevention of viral and bacterial infections of the upper respiratory tract consists of increasing immunity, hardening children, and proper diet. In winter, pediatricians recommend giving children vitamins in the form of multivitamin preparations.

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Forecast

The prognosis of whooping cough and acute stenosing laryngotracheitis depends primarily on their timely treatment. Parents need to remember that a barking cough in a child with a fever is fraught with asphyxia - a life-threatening condition.

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