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. [16]
The prodrome is usually an upper respiratory infection, followed by progression to higher fever, cough, inspiratory stridor, and a variable degree of respiratory distress. [8]
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.
A study by Patnaik et al found that among pediatric patients aged between 5 and 18 years, bacterial tracheitis was one of the most common causes of stridor. [17]
Physical Examination
The following physical findings may be noted:
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Inspiratory stridor (with or without expiratory stridor)
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Fever
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Barklike or brassy cough
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Hoarseness
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Worsening or abruptly occurring stridor
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Varying degrees of respiratory distress
Retractions
Dyspnea
Nasal flaring
Cyanosis
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Sore throat, odynophagia
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Dysphonia
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No drooling
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No specific position of comfort (The patient may lie supine.)
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Steeple sign.
