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Croup, the new Covid symptom associated with children

Two years after the outbreak of the pandemic, alterations related to SARS CoV2 infection continue to appear. The arrival of Ómicron and the circulation of its subvariant BA.2 (Silent Ómicron) has revealed a new, previously undetected symptom of the disease that affects young children. It is called croup or laryngotracheobronchitis and consists of an inflammation of the trachea and larynx, caused by a contagious viral infection that causes coughing, a loud noise called ‘stridor’ and, sometimes, difficulty breathing during inspiration. Its symptoms include fever, runny nose, and barking cough.

Most children have a single episode of croup, although there are some who have repeated episodes (called spasmodic croup) that are started by viral infections that gradually decrease in frequency and severity.

Doctors at Boston Children’s Hospital (United States) found this new complication of the coronavirus after 75 children came to their emergency room with laryngotracheobronchitis and Covid-19 between March 1, 2020 and January 15, 2022.

Some of the cases were especially severe, requiring hospitalization and a higher dose of medication compared to croup caused by other viruses. More than 80% occurred during the Omicron wave.

Ryan Brewster, a doctor at this hospital and co-author of the study, assured that there was a very clear relationship from the moment in which Ómicron became the dominant variant until the moment in which an increase in the number of patients with laryngotracheobronchitis began to be seen.

The majority of children with Covid-19 and laryngotracheobronchitis who went to the emergency room were under two years old and 72 percent were boys. Although no children died, nine of the 75 children needed to be hospitalized and four of them required intensive care.

“The omicron variant has been shown to be a disease of the upper respiratory tract rather than the lower respiratory tract in the lungs and therefore people dismiss it as a simple cold. But I think what we recorded is that, of the upper respiratory tract infections, of the viral infections, croup is one of the most serious and ends up sending children to the ICU,” warned Indi Trehan, co-author of the study and a doctor. of infectious diseases, virology and emergency medicine at Seattle Children’s Hospital.

For her part, Claudia Hoyen, a pediatric infectious disease specialist at Rainbow Babies and Children’s University Hospital in Cleveland, who did not collaborate with these studies, clarified that croup season in her area usually arrives in the fall. So when more children started showing up with croup in December, during the Omicron wave, she suspected there was something different about this variant. “We know that nasal tissues are much more receptive to Omicron, and the lung is not,” Hoyen said. «We have not seen croup with other waves. This one has been different.”