eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Bacterial Tracheitis

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
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; 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
Contributor Information and Disclosures

Updated: Jun 23, 2009

Introduction

Background

Although bacterial tracheitis is an uncommon infectious cause of acute upper airway obstruction, it is currently more prevalent than acute epiglottitis. Patients may present with crouplike symptoms, such as barking cough, stridor, and fever; however, patients with bacterial tracheitis do not respond to standard croup therapy and may experience acute respiratory decompensation.1

Pathophysiology

Bacterial tracheitis is a diffuse inflammatory process of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes within the trachea. The major site of disease is at the cricoid cartilage level, the narrowest part of the trachea. Acute airway obstruction may develop secondary to subglottic edema and sloughing of epithelial lining or accumulation of mucopurulent membrane within the trachea. Signs and symptoms are usually intermediate between those of epiglottitis and croup.

Bacterial tracheitis may be more common in the pediatric patient because of the size and shape of the subglottic airway. The subglottis is the narrowest portion of the pediatric airway, assuming a funnel-shaped internal dimension. In this smaller airway, relatively little edema can significantly reduce the diameter of the pediatric airway, increasing resistance to airflow and work of breathing. With appropriate airway support and antibiotics, most patients improve within 5 days.

Although the pathogenesis of bacterial tracheitis is unclear, mucosal damage or impairment of local immune mechanisms due to a preceding viral infection, an injury to trachea from recent intubation, or trauma may predispose the airway to invasive infection with common pyogenic organisms.

Frequency

United States

Tan and Manoukian reported that 500 children were hospitalized for croup at one pediatric hospital over a 32-month period.2 Approximately 98% had viral croup, and 2% had bacterial tracheitis. Cases usually occur in the fall or winter months, mimicking the epidemiology of viral croup.

International

According to a recent study, bacterial tracheitis remains a rare condition, with an estimated incidence of approximately 0.1 cases per 100,000 children per year.3

Mortality/Morbidity

The predominant morbidity and mortality is related to the potential for acute upper airway obstruction and induced hypoxic insults. The mortality rate has been estimated at 4-20%. In the acute phase, patients generally do well if the airway is adequately managed and if antibiotic therapy is promptly initiated.

Sex

In most epidemiologic studies, male cases are preponderant. Gallagher et al reported a male-to-female predominance of 2:1.4

Age

Bacterial tracheitis may occur in any pediatric age group. Gallagher et al reported 161 cases of patients younger than 16 years.4 The age range was from 3 weeks to 16 years, with a mean age of 4 years. This is in contrast to viral laryngotracheobronchitis, which occurs in patients aged 6 months to 3 years.

Clinical

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.5
  • 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.

Physical

  • 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.)

Causes

  • 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)

More on Bacterial Tracheitis

Overview: Bacterial Tracheitis
Differential Diagnoses & Workup: Bacterial Tracheitis
Treatment & Medication: Bacterial Tracheitis
Follow-up: Bacterial Tracheitis
Multimedia: Bacterial Tracheitis
References

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

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

  4. 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].

  5. 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].

  6. [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].

  7. [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].

  8. 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].

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

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

  11. 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].

  12. 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].

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

Further Reading

Keywords

bacterial tracheitis, bacterial croup, membranous croup, membranous laryngotracheobronchitis, pseudomembranous croup, tracheitis, acute upper airway obstruction, epiglottitis, croup, laryngotracheobronchitis, Staphylococcus aureus infection, Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, Klebsiella, Pseudomonas, Peptostreptococcus, Bacteroides, Prevotella, Mycoplasma pneumoniae, Mycobacterium tuberculosis, treatment, diagnosis

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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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

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

 
 
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