Necrosis and denudation of ciliated epithelial cells of the bronchi, with inflammation, cellular infiltration, edema and mucus secretion-infection initiates in the respiratory tract mucosa. viral replication progresses along the respiratory epithelium, leading to a loss and desquamation of respiratory epithelial cells, associated with inflammatory cell infiltration. direct cytopathic effects are believed to be responsible for most of the pathological changes, but inflammation is also involvedpathogenesis -croup (acute laryngotracheobronchitis)most of the symptoms are the result of inflammation and seem proportional to viral replication (in the case of hpivs at least) in both the upper and lower respiratory tract (respiratory epithelium). viral infection is initiated in the upper respiratory tract, with inflammation of the nasal passages and nasopharynx, and then moves to the lower respiratory tract. stridor, hoarseness and cough result from the inflammation of the larynx and trachea, especially at the subglottic level.
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