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.^[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.

Physical

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.)

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^[11]

Differential Diagnoses

Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 2009 Feb. 51(1):110-3. [QxMD MEDLINE Link].
Johnson D. Croup. Clin Evid (Online). 2009 Mar 10. 2009:[QxMD MEDLINE Link].
Holmes A. Croup: What It Is and How to Treat It. US Pharm. 2013. 38(7):47-50.
Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct. 27(10):950-3. [QxMD MEDLINE Link].
Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73. [QxMD MEDLINE Link].
Tan AK, Manoukian JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol. 1992 Feb. 21(1):48-53. [QxMD MEDLINE Link].
Dawood FS, Chaves SS, Pérez A, Reingold A, Meek J, Farley MM, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis. 2014 Mar 1. 209(5):686-94. [QxMD MEDLINE Link].
Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. 2009 Apr 28. 1-10. [QxMD MEDLINE Link].
Gallagher PG, Myer CM 3d. An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. Pediatr Emerg Care. 1991 Dec. 7(6):- Myer CM 3d. [QxMD MEDLINE Link].
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6. [QxMD MEDLINE Link].
Hopkins BS, Johnson KE, Ksiazek JM, et al. H1N1 influenza A presenting as bacterial tracheitis. Otolaryngol Head Neck Surg. 2010 Apr. 142(4):612-4. [QxMD MEDLINE Link].
Mandal A, Kabra SK, Lodha R. Upper Airway Obstruction in Children. Indian J Pediatr. 2015 Aug. 82 (8):737-44. [QxMD MEDLINE Link].
Fergie J, Purcell K. The treatment of community-acquired methicillin-resistant Staphylococcus aureus infections. Pediatr Infect Dis J. 2008 Jan. 27(1):67-8. [QxMD MEDLINE Link]. [Full Text].
[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. 2004 Mar 26. 53:1-36. [QxMD MEDLINE Link].
Gross JH, Giraldez-Rodriguez LA, Klein AM. Bacterial Laryngotracheitis and Associated Upper Airway Obstruction: A Case Series. Ann Otol Rhinol Laryngol. 2015 Dec. 124 (12):1002-5. [QxMD MEDLINE Link].
Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. 1998 Sep. 27(3):458-62. [QxMD MEDLINE Link].
Brook I. Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. 1997 Feb. 13(1):16-8. [QxMD MEDLINE Link].
Cherry JD. Croup (laryngitis, laryngotracheitis, spasmodic croup, and laryngotracheobronchitis). Textbook of Pediatric Infectious Diseases. 1998. 234-238.
Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis. 1990 Sep-Oct. 12(5):729-35. [QxMD MEDLINE Link].
Eckel HE, Widemann B, Damm M, Roth B. Airway endoscopy in the diagnosis and treatment of bacterial tracheitis in children. Int J Pediatr Otorhinolaryngol. 1993 Aug. 27(2):147-57. [QxMD MEDLINE Link].
Rotta AT, Wiryawan B. Respiratory emergencies in children. Respir Care. 2003 Mar. 48(3):248-58; discussion 258-60. [QxMD MEDLINE Link].
Burton LV, Silberman M. Bacterial Tracheitis. 2018 Jan. [QxMD MEDLINE Link]. [Full Text].
Casazza G, Graham ME, Nelson D, Chaulk D, Sandweiss D, Meier J. Pediatric Bacterial Tracheitis-A Variable Entity: Case Series with Literature Review. Otolaryngol Head Neck Surg. 2018 Oct 23. 194599818808774. [QxMD MEDLINE Link].

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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, 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, , 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, , MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.