Barking cough in a child with a fever

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

Causes of the barking cough in a child with a fever

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

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

In addition, enzymatically active bacterial cytotoxins bind to receptors of epithelial cell membranes and disrupt the intracellular interaction of G proteins, increasing the irritability of the endings of nerve cells of the epithelium - cough irrigation and C-receptors. As a result, the center of the cough of the medulla oblongata usually receives afferent signals from the irritated receptors more often than usual, which also 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 emetic, respiratory and vasomotor nerves.

Because of age-related anatomical features of the airway in children up to two years of inflammation with laryngitis extends to the trachea and bronchi. A spontaneously occurring condition, accompanied by barking cough, hyperthermia and other symptoms, is diagnosed by pediatricians as an acute stenosing (narrowing lumen) laryngotracheitis or false groats.

The cause of the development of acute laryngotracheitis are orthomixoviruses of influenza, parainfluenza virus Respirovirus Paramyxoviridae (which causes almost a third of all cases of acute respiratory viral infection); adenovirus infection; respiratory syncytial virus of the family Pneumoviridae (HRSV). The development of pathology is possible with such viral diseases as varicella (the causative agent is herpesvirus Varicella Zoster) and measles caused by the paramyxovirus Measles virus. It is not excluded and the microbial etiology of false croup - with infection of the mucous membrane of the respiratory tract by 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 larynx lumen, which irritates the reflexogenic zones of the mucosal epithelium of the larynx and provokes a reflex spasm of its muscles.

Risk factors

The main risk factors for pertussis infection are the absence of DPT vaccination in children and contact with sick people. And the risk of developing false croup in young children (especially in boys) is associated with weakened immunity, birth trauma, overweight of the child, as well as congenital anomalies of the respiratory tract or a genetic predisposition to allergies.

[1],

Symptoms of the barking cough in a child with a fever

The first signs of barking cough in a child with pertussis temperature appear only after the catarrhal stage of the disease (which differs little from the usual cold and can last for two weeks).

On the paroxysmal (convulsive or spasmodic) stage of whooping cough, symptoms of barking cough in a child with fever (subfebrile) - spontaneously arising cough spasms - are accompanied by a sharp wheezing (stridor) and subsequent multiple non-stop cough points (for one minute and longer). During the cough tongue is stuck out of the mouth; Because of the narrowing of the glottis, each coughing jerk is accompanied by a sound reminiscent of a muffled dog barking. As they say, the child coughs until vomiting - 20 or more times a day.

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

In infancy, children can turn blue and blush, take a mouthful of air, and often there is apnea - a brief respiratory arrest.

It should be noted such symptoms of dehydration in this disease, like increased thirst and dry mouth, decreased diuresis, lethargy, and cryeless crying.

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

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

• night attacks of coughing with suffocation;
• a hoarse muffled voice;
• shortness of breath, shortness of breath;
• breathing stridoroznoe (with a whistle when inhaling), with the accumulation of a mucous secret - bubbling;
• difficulty swallowing;
• cyanosis of the skin in the mouth;
• swollen cervical lymph nodes.

Depending on the degree of narrowing of the larynx - compensated, subcompensated, decompensated or terminal - the restless behavior of a sick child with an increased pulse and shortness of breath passes into a state of inhibition, in which the heart rate is unstable (with periods of bradycardia), the thorax sagging (exhaling with exhalation ), breathing becomes superficial. Threatening the life of the child, the terminal stage develops very quickly and is manifested by severe swelling of the larynx, signs of suffocation, impaired pulse, diffuse cyanosis of the skin (indicating total hypoxia), loss of consciousness.

[2], [3], [4]

Complications and consequences

In whooping cough, the consequences and complications of barking cough consist in the development of bronchitis, bronchiolitis, pneumonia, bronchopneumonia; the appearance of hemorrhages under the conjunctiva of the eyes; rupture of the hyoid frenum (due to protrusion of the tongue with a strong cough). There may be complications such as the collapse of the walls of segments of pulmonary (atelectasis), right-sided enlargement of the heart (due to pulmonary hypertension). Encephalopathy occurs as a result of partial paralysis of the cranial nerves.

Acute congestive heart failure and asphyxia in whooping cough - the reason for stopping breathing and death in infants and children up to a year (in 1-2% of cases). In such situations, endotracheal intubation or intensive therapy with artificial ventilation should be performed. That is why for any intensity of barking cough in a child with a temperature, treatment should be performed in a stationary setting.

Consequences and complications of acute stenosing laryngotracheitis: dehydration, stenosis of the larynx and asphyxia; bleeding from the nose and ears; perforation of the tympanic membrane; convulsions; inguinal or umbilical hernia; rectal prolapse (prolapse of the rectum); secondary microbial pneumonia, bronchopneumonia, otitis media.

[5], [6], [7]

Diagnostics of the barking cough in a child with a fever

Because barking cough in a child with a temperature is a symptom, the diagnosis should determine its specific cause.

For this - in addition to examining the child's throat, auscultation of his lungs and assessing the clinical picture - the following tests are needed:

• general blood analysis;
• bakposev from pharynx (smear from pharyngeal mucosa) or examination of a sputum sample for pathogenic microflora (including strepto and staphylococci);
• serological analysis of the smear from the nasopharynx (to identify B. Pertussis);
• enzyme immunoassay (for specific antibodies);
• PCR analysis of blood.

Instrumental diagnostics: laryngoscopy and chest X-ray.

[8], [9], [10],

Differential diagnosis

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

Treatment of the barking cough in a child with a fever

The etiological treatment of barking cough in a child with pertussis-related temperature 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 body weight of the child per day (the daily dose is divided into 4 divided doses); duration of application - two weeks;

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

It is believed that the use of antibiotics is advisable only in the initial stage of whooping cough, but the possible complication of the disease by the attachment of a secondary infection makes most domestic infectious disease insure and apply these medicines in the subsequent stage - when a barking cough appears.

It should be borne in mind that in the room where the sick child is, there must necessarily be increased humidity of the air, this helps improve the child's condition and reduce the frequency of coughing attacks. To do this, you can dial into the hot water bath - to create as much steam as possible, and for 10-15 minutes bring the child into the bathroom.

Do not put the child, it is better to keep it in a vertical or semi-sitting position.

It is necessary as often as possible to water a child - to prevent dehydration and dilution of sputum.

With pertussis barking coughing absolutely counter-indicative are such methods of treatment of cold cough as mustard, hot foot baths, grinding of the chest with ointments, the use of cans.

Children under the age of two years are not prescribed preparations in the form of a spray, since their use can cause spasm of the larynx and suffocation.

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

• glucocorticoids Prednisolone, Dexamethasone - per day 0,25-0,5 mg per day (by mouth or parenterally);
• antihistamines (Tavegil, Cetirizine, Suprastin, Fenistil) - to reduce swelling of the mucous membrane of the respiratory tract;

Cough can be prescribed drugs acting on the cough center of the brain. Syrup Broncholitin (Bronchoton) with glaucine hydrochloride and ephedrine may be used only after three years - one teaspoonful three times during the day. The drug may call for nausea and dizziness.

Tusuprex (Oxeladine, Neobeks, Pakseladin, Pectussil, Tussimol and other trade names) give children 5 mg each (half a tablet of 0.01 g grind into powder and mix with water) three times a day, after a year - 10 mg. As a side effect, temporary problems with digestion are possible.

Carbocysteine (Mukosol, Mukolik, Mukodin, Fljuditik, etc.) - expectorant, mucolytic and respiratory-stimulating syrup. Children under the age of five are recommended to take half a teaspoon to three times a day. Among the contra-indications of this drug are acute forms of cystitis and glomerulonephritis, and among its possible side effects are rash on the skin, headache, nausea, diarrhea and gastrointestinal bleeding.

Alternative treatment of barking cough in a child with a temperature consists of five minutes of soda inhalation (a teaspoon of baking soda for 250 ml of boiling water) or inhalation with alkaline mineral water (sprayed into the throat and larynx from the inhaler).

Physiotherapy treatment also includes oxygen therapy (used in severe pertussis).

And surgical treatment with a critical narrowing of the lumen of the pharynx implies intubation of the trachea with the introduction of the endotracheal tube, and in case of suffocation on the decompensated or terminal stage of the false croup - tracheotomy with the installation of a tube for breathing.

Prevention

Currently, the main prevention of the infection of children with whooping cough is the timely vaccination of the DTP vaccine.

And the prevention of viral and bacterial infections of the upper respiratory tract is to increase immunity, tempering children, a proper diet. In winter, pediatricians recommend giving children vitamins in the form of multivitamin preparations.

[11], [12], [13]

Forecast

The prognosis of whooping cough and acute stenosing laryngotracheitis, first of all, depends on their timely treatment. Parents need to remember that barking cough in a child with a temperature is fraught with asphyxia - a condition dangerous to life.

[14], [15]