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Volume 350:1788-1790 April 22, 2004 Number 17
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Human Metapneumovirus and Lower Respiratory Tract Disease in Children

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by Williams, J. V.
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To the Editor: The case definition of croup given by Williams et al. in their study of metapneumovirus (Jan. 29 issue)1 seems misleading. The authors state that croup is an "acute lower respiratory tract infection characterized by hoarseness, cough, and stridor." On the contrary, croup is classified as an acute upper-airway disease in several textbooks of pediatrics.2,3,4 Recognizing croup as an important cause of acute upper-airway obstruction and its pertinent features, as distinct from life-threatening bacterial epiglottitis, is the classic point made in medical teaching worldwide.


Hok-Kung Ho, M.B., B.S.
University of Hong Kong
Hong Kong, China
a8914760@graduate.hku.hk

  1. Williams JV, Harris PA, Tollefson SJ, et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 2004;350:443-450. [Free Full Text]
  2. Orenstein DM. Acute inflammatory upper airway obstruction. In: Behrman RE, Kliegman RM, Arvin AM, eds. Nelson textbook of pediatrics. 15th ed. Philadelphia: W.B. Saunders, 1996:1201-5.
  3. Healy G, Avery ME. Upper airway disorders. In: Avery ME, First LR, eds. Pediatric medicine. 2nd ed. Baltimore: Williams & Wilkins, 1994:1347-56.
  4. McKenzie S, Silverman M. Respiratory disorders. In: Campbell AGM, McIntosh N, eds. Forfar & Arneil's textbook of pediatrics. 5th ed. New York: Churchill Livingstone, 1998:489-583.
 
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