Bacterial Tracheitis Clinical Presentation

Updated: Dec 14, 2017
  • Author: Sujatha Rajan, MD; Chief Editor: Russell W Steele, MD  more...
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Presentation

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.

  • 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.

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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.)

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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]

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