Bacterial tracheitis

Background

• Bacterial infection of tracheal epithelium
  • Often secondary infection after viral illness
  • S. Aureus most common, also strep spp, H. Influenza and anaerobes
• Peak age is 3-5 years old
  • Occurs throughout childhood and adulthood

Clinical Features

• Severely ill child, starts out as viral prodrome
  • Followed by inspiratory and expiratory stridor, resp distress, and copious purulent secretions
• Difficult to differentiate from croup and epiglottis
  • Severe decompensation, high fever, purulent secretions help differentiate
  • May also have concomitant pneumonia

Diagnosis

• Clinical diagnosis
• XR neck may show subglottic narrowing with ragged tracheal epithelium
• CXR may show concominant Pneumonia
• Emergent bronchoscopy is diagnostic and therapeutic

Treatment

• Intubation, emergent, usually necessary
• Bronchoscopy to confirm dx, rule out supraglottic pathology
• Antibiotics
  • third gen cephalosporin and vanco/clinda

Disposition

• ICU admit
• Often require prolong intubation, 4-5 days