Bacterial tracheitis (quick review)

5 Apr

= an invasive exudative bacterial infection of the soft tissues of the trachea. 

almost always occurs in the setting of prior airway mucosal damage, as with antecedent viral infection

 

tracheal mucosa is edematous and hyperemic.

Patches of mucosa may be necrotic or sloughed. 

 

RARE.

 

The majority of cases occur in the fall and winter, coinciding with the typical seasonal epidemics of parainfluenza, respiratory syncytial virus (RSV), and seasonal influenza. 

 

In a systematic review of 300 cases, the frequency of bacterial isolates (excluding possible contaminants such as Streptococcus viridans and coagulase-negative staphylococci) was as follows: 

  • S. aureus (41 percent)
  • S. pneumoniae (15 percent)
  • S. pyogenes (9 percent)
  • M. catarrhalis (12 percent)
  • Haemophilus influenzae (18 percent)

 

In most children, signs suggestive of viral URI are present for one to three days before more severe signs of illness develop, such as stridor and dyspnea

In a minority of children, onset is fulminant, with progression to acute respiratory distress less than 24 hours after the onset of initially minor symptoms. Most children with fulminant onset are toxic-appearing.

 

Definitive diagnosis of bacterial tracheitis requires direct visualization of an inflamed, exudate-covered trachea.

 

TREATMENT:

  • maintenance of the airway
  • fluid resuscitation (if needed),
  • antibiotics
  • Some children require emergent or urgent evaluation of the airway via endoscopy. (generally best performed in the operating room/ICU/etc.)

 

Submitted by H. Reed-Day.

 

References: Upper Airway Obstruction: Infectious Cases Stevenson MD – CPEM – 2002 Sep; 3(3); 163-172; picture

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