A 1-year-old child with a case of URTI suddenly developed noisy respirations with difficult inspiration, intercostal retractions, and barking cough on the 2nd night after the disease onset. What is the most likely diagnosis?

Answer options

1. Bronchial asthma
2. Acute bronchitis
3. Acute bronchiolitis
4. Acute pulmonary inflammation
5. Stenosing laryngotracheobronchitis

Explanation

Parainfluenza infection in children is associated with an acute febrile illness in up to 80 % of cases. Initial symptoms include coryza, sore throat, hoarseness, and dry cough. In croup, a brassy or barking cough may progress to stridor and occasionally to airway obstruction. The anteroposterior radiograph of the neck shows glottic and subglottic narrowing (‘steeple sign’) which differentiates croup from epiglottitis. In cases of bronchiolitis and pneumonia, progressive cough is accompanied by wheezing, tachypnea, and hypoxemia. Chest X-ray examination may reveal air trapping and interstitial infiltrates. In older children and adults, HPIV infections tend to be milder and present as URTI Infectious Diseases / Jonathan Cohen, William Powderly, Steven Opa. – l3rd edition. – 2010. – P. 1606–1607