Bacterial Tracheitis Clinical Presentation

Updated: Nov 26, 2018
  • Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD  more...
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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. [10]

  • The prodrome is usually an upper respiratory infection, followed by progression to higher fever, cough, inspiratory stridor, and a variable degree of respiratory distress. [23]

  • 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.



The following physical findings may be noted:

  • Inspiratory stridor (with or without expiratory stridor)

  • Fever

  • 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.)



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 [11]