Bacterial tracheitis

Background
  • Bacterial infection of tracheal epithelium
  • Peak age is 3-5 years old
    • Occurs throughout childhood and adulthood

Clinical Features
  • Severely ill child, starts out as viral prodrome
  • Difficult to differentiate from croup and epiglottitis
    • Severe decompensation, high fever, purulent secretions help differentiate
    • May also have concomitant pneumonia
  • May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement

Differential Diagnosis

Pediatric stridor
  • A minimal amount of edema or inflammation in the pediatric airway can result in significant obstruction
    • Can lead to rapid decompensation

<6mo
  • Laryngotracheomalacia
    • Accounts for 60%
    • Usually exacerbated by viral URI
    • Dx w/ flexible fiberoptic laryngoscopy
  • Vocal cord paralysis
    • Stridor associated w/ feeding problems, hoarse voice, weak and/or changing cry
    • May have cyanosis or apnea if bilateral (less common)
  • Subglottic stenosis
    • Congenital vs 2/2 prolonged intubation in premies
  • Airway hemangioma
    • Usually regresses by age 5
    • Associated w/ skin hemangiomas in beard distribution
  • Vascular ring/sling

>6mo
  • Croup
    • viral laryngotracheobronchitis
    • 6 mo- 3 yr, peaks at 2 yrs
    • Most severe on 3rd-4th day of illness
    • Steeple sign not reliable- diagnose clinically
  • Epiglottitis
    • H flu type B
      • Have higher suspicion in unvaccinated children
    • Rapid onset sore throat, fever, drooling
    • Difficult airway- call anesthesia/ ENT early
  • Bacterial tracheitis
    • Rare but causes life-threatening obstruction
    • Sx of croup + toxic-appearing = bacterial tracheitis
  • Foreign body (sudden onset)
    • Marked variation in quality or pattern of stridor
  • Retropharyngeal abscess
    • Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension

Evaluation
  • Clinical diagnosis
  • Gram stain with predominance of one organism, differentiating from colonization
  • XR neck may show subglottic narrowing with ragged tracheal epithelium
  • CXR may show concomitant pneumonia
  • Emergent bronchoscopy is diagnostic and therapeutic

Management
  • Intubation, emergent, usually necessary
  • Bronchoscopy to confirm diagnosis, rule out supraglottic pathology
  • Antibiotics[1]

Disposition
  • Admit to ICU
  • Often require prolonged intubation (4-5 days)

Complications

See Also

References
  1. Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment
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