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Includes Expert Content
Adult Croup?!
An_187582 posted:
Dr. Moser,

I have been very sick for the last week. Fever started last Monday night, fairly low, but bad chills. I felt OK Tuesday, and went to work Wednesday. I sat near an AC vent and got chilled and couldn't get warm. I left work early to go to the doctor. Little air movement, couldn't take even a shallow breath without coughing. Dr said severe bronchitis in both lungs. That night my temp went to 103.4 with a bad cough. White blood cell count was 20,000+. I was started on antibiotic and prednesone.

I saw the doctor again on Friday with little improvement, and was told to go to an ER or urgent care clinic if I was the slightest bit concerned about my ability to breathe. She wanted a chest x-ray. I have had a lot of radiation exposure over the last few years and asked if it was absolutely necessary. She said no. She was still pretty sure it was pneumonia.

I went back today with marked improvement in airflow, but she was still very concerned and ordered the chest x-ray which was clear. She also ordered a new CBC to check for shifts in the count. She called the hospitalist and discussed admitting me to the hospital, but they decided that I had improved enough that the hospital environment would probably set me back.

I called my allergist about another matter and the nurse that got the voice mail message was very concerned about me. She comunicated between the dr and me about 3 times with the details of the last week. The dr thinks it is croup. I am 40+ years old. Is that even possible?

Im the last year my asthma has been down graded to severe which is why I was so agressive about seeing the doctor for this. I treated the asthma agressively switching to nebulizer meds as I could not use MDIs with the shallowness of my breathing. My combo med was switched to neb Pulmacort and albuterol treatments every 3 hours. As soon as I started to inhale I would start coughing. The neb allowed for gradual increasing the depth of my breathing so the medicine could get deeper into my lungs. That had never happened to me before. It has been a rather scary week.

So, can an adult get croup? Is it called croup in an adult?

Thank you for your time.
Rod Moser, PA, PhD responded:
Croup is really "laryngotracheobronchiolitis"...a disease that involves the larynx (voice box), the trachea (windpipe), and parts of the lungs. Kids and adults have all of these things, but croup is typically a disease of the young. Clearly, you had a reactive airway disease and they called it croup. Croup by any other name would still be miserable.

Did they test you for pertussis (whooping cough)? We are in the midst of a mini-epidemic and resurgence of this old disease. Maybe it was considered. What antibiotic did they give you, since pertussis can be treated by one of them.

You are on steroids and a bronchiodilator, so should should be improving. Croup....if you indeed had "croup" is usually viral, so antibiotics tend not to be as helpful (often worthless) in cases of croup. If you are getting better, that is more important than the accuracy (or name) of the diagnosis.
An_187583 replied to Rod Moser, PA, PhD's response:
Dr. Moser,

Thank you for the very prompt reply.

I was put on biaxin 500 mg twice a day as my pulmo and I had been thinking my sever asthma was due to either Neutrophilic asthma or bronchiecstasis. She was out of town last week, but her nurse did give me a sputum sample kit but I was unable to produce an sputum sample. A not productive cough is VERY rare for me. They did not test for pertussis. I did have a booster for measles or mumps (which ever was going around) in my 30's which I believe also had pertusis with it.

Very true about the lable, not really very important if the treatment works.
Rod Moser, PA, PhD replied to An_187583's response:
No, the measles and mumps vaccine does not contain the pertussis vaccine. Besides, those of us who either had pertussis as a child, or the vaccine later in life, are not all "immune". The NEW vaccine is recommended for all adults, since adults are the ones that are transmitting it to the babies.

Good news, however. Biaxin would most likely have taken care of pertussis.
Orchardparkny replied to Rod Moser, PA, PhD's response:
I hate to jump in on an old reply and hope you can still assist. My doctor also said that I have croup and put me on steroids as well as another assist my question is how much down time should be taken to put this at bay my doctor said at least 3 days or more is that a true assiment?
Rod Moser, PA, PhD replied to Orchardparkny's response:
Any viral infection of the respiratory tract....croup, bronchitis, etc.....tends to last about a week, whether you treat it or not. On steroids, I would expect you to feel better in a few days. If you ar not, the validity of the diagnosis may be in question. Croup-like illnesses can have similar symptoms as asthma and several other respiratory diseases, so it would be best to be re-examined later this week if you are not getting better.
Orchardparkny replied to Orchardparkny's response:
Wow thank you so much for you quick reply , one final question how likely is this form of illness to be passed on in normal contact with others ? Thank you again.
Rod Moser, PA, PhD replied to Orchardparkny's response:
There are no croup-specific viruses, other than RSV. Basically any of the 200 or so respiratory viruses can decide to take up residence in your lungs or bronchioles, but that same virus can just as easily cause a runny eye....or even a rash on someone else.

So....contagious? Not very likely, especially now. If you are an adult that had RSV, it is possible to pass in on to a baby that has a very immature immune system, or even the elderly who suffer from the same age-related immune deficiency or vulnerability.

For most viruses, we assume the person is contagioius a day BEFORE they no they are sick (!), and about two or three days after that....even if you are still coughing and have a runny nose long after thaty period..

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