Bacterial Tracheitis Clinical Presentation

  • Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 15, 2010
 

History

Symptoms of bacterial tracheitis may be intermediately between those of epiglottitis and croup. Presentation is either acute or subacute.

  • In the classic presentation patients present acutely with fevers, toxic appearance, stridor, tachypnea, respiratory distress, and high WBC counts. Cough is frequent and not painful.
  • In a study by Salamone et al, a significant subset of older children (mean age, 8 y) did not have severe clinical symptoms.[6]
  • The prodrome is usually an upper respiratory infection, followed by progression to higher fever, cough, inspiratory stridor, and a variable degree of respiratory distress.
  • Patients may acutely decompensate with worsening respiratory distress due to airway obstruction from a purulent membrane that has loosened.
  • Patients have been reported to present with symptoms and signs of bacterial tracheitis and multiorgan failure due to exotoxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes in the trachea.
  • A high index of suspicion for bacterial tracheitis is needed in children with viral croup–like symptoms who do not respond to standard croup treatment or clinically worsen.
Next

Physical

The following physical findings may be noted:

  • Inspiratory stridor (with or without expiratory stridor)
  • Barklike or brassy cough
  • Hoarseness
  • Worsening or abruptly occurring stridor
  • Varying degrees of respiratory distress
    • Retractions
    • Dyspnea
    • Nasal flaring
    • Cyanosis
  • Sore throat, odynophagia
  • Dysphonia
  • No drooling
  • No specific position of comfort (The patient may lie supine.)
Previous
Next

Causes

The following causes have been noted:

  • S aureus: Community-associated methicillin-resistant S aureus (CA-MRSA) has recently emerged as an important agent in the United States; this could result in a greater frequency of MRSA strains that cause tracheitis.
  • S pyogenes, Streptococcus pneumoniae, and other alpha hemolytic streptococcal species
  • Moraxella catarrhalis: Recent reports suggest it is a leading cause of bacterial tracheitis and associated with increased intubation.
  • Haemophilus influenzae type B (Hib): This cause is less common since the introduction of the Hib vaccine.
  • Klebsiella species
  • Pseudomonas species
  • Anaerobes
  • Peptostreptococcus species
  • Bacteroides species
  • Prevotella species
  • Other
    • Mycoplasma pneumoniae
    • Mycobacterium tuberculosis (endobronchial disease)
    • H1N1 influenza[7]
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Sujatha Rajan, MD  Assistant Professor of Pediatrics, Albert Einstein School of Medicine; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Diseases, Schneider Children's Hospital, North Shore-Long Island Jewish Health System

Sujatha Rajan, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kathryn Clark Emery, MD  Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Consulting Staff, Department of Emergency Medicine, Children's Hospital of Denver

Kathryn Clark Emery, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Sunil K Sood, MBBS, DCh, MD  Professor of Clinical Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine; Chief, Pediatric Infectious Diseases, Firm Director, Pediatric Unit, Schneider Children's Hospital at North Shore, North Shore University Hospital

Sunil K Sood, MBBS, DCh, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: None None None

References

  1. Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. Feb 2009;51(1):110-3. [Medline].

  2. Johnson D. Croup. Clin Evid (Online). Mar 10 2009;2009:[Medline].

  3. Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. Feb 1992;21(1):48-53. [Medline].

  4. Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. Apr 28 2009;1-10. [Medline].

  5. Gallagher PG, Myer CM 3d. An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. Pediatr Emerg Care. Dec 1991;7(6):- Myer CM 3d. [Medline].

  6. Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. Dec 2004;131(6):871-6. [Medline].

  7. Hopkins BS, Johnson KE, Ksiazek JM, et al. H1N1 influenza A presenting as bacterial tracheitis. Otolaryngol Head Neck Surg. Apr 2010;142(4):612-4. [Medline].

  8. [Best Evidence] Fergie J, Purcell K. The treatment of community-acquired methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J. Jan 2008;27(1):67-8. [Medline]. [Full Text].

  9. [Guideline] Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. Mar 26 2004;53:1-36. [Medline].

  10. Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. Sep 1998;27(3):458-62. [Medline].

  11. Brook I. Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. Feb 1997;13(1):16-8. [Medline].

  12. Cherry JD. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). Textbook of Pediatric Infectious Diseases. 1998;234-238.

  13. Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis. Sep-Oct 1990;12(5):729-35. [Medline].

  14. Eckel HE, Widemann B, Damm M, Roth B. Airway endoscopy in the diagnosis and treatment of bacterial tracheitis in children. Int J Pediatr Otorhinolaryngol. Aug 1993;27(2):147-57. [Medline].

  15. Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. Mar 2003;48(3):248-58; discussion 258-60. [Medline].

 
Previous
Next
 
Steeple sign.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.