Human Metapneumovirus and Lower Respiratory Tract Disease in Children

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Abstract
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.2-4 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.