Bacterial tracheitis: Difference between revisions

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


== Clinical Features==
==Clinical Features==
*Severely ill child, starts out as viral prodrome  
*Severely ill child, starts out as viral prodrome  
**Followed by inspiratory and expiratory stridor, resp distress, and copious purulent secretions  
**Followed by inspiratory and expiratory [[stridor]], [[respiratory distress]], and copious purulent secretions  
*Difficult to differentiate from croup and epiglottis
*Difficult to differentiate from [[croup]] and [[epiglotitis]]
**Severe decompensation, high fever, purulent secretions help differentiate  
**Severe decompensation, high [[fever]], purulent secretions help differentiate  
**May also have concomitant pneumonia
**May also have concomitant [[pneumonia]]
*May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement


==Differential Diagnosis==
==Differential Diagnosis==
{{Pediatric stridor DDX}}
{{Pediatric stridor DDX}}


== Diagnosis==
==Evaluation==
*Clinical diagnosis  
*Clinical diagnosis  
*Gram stain with predominance of one organism, differentiating from colonization
*Gram stain with predominance of one organism, differentiating from colonization
*XR neck may show subglottic narrowing with ragged tracheal epithelium  
*XR neck may show subglottic narrowing with ragged tracheal epithelium  
*CXR may show concominant [[Pneumonia]]
*[[CXR]] may show concomitant [[pneumonia]]
*Emergent bronchoscopy is diagnostic and therapeutic
*Emergent bronchoscopy is diagnostic and therapeutic


== Treatment  ==
==Management==
*Intubation, emergent, usually necessary  
*Intubation, emergent, usually necessary  
*Bronchoscopy to confirm dx, rule out supraglottic pathology  
*Bronchoscopy to confirm diagnosis, rule out supraglottic pathology  
*Antibiotics<ref>Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment</ref>
*Antibiotics<ref>Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment</ref>
**Third generation cephalosporin (cefotaxime or ceftriaxone)
**Third generation cephalosporin (cefotaxime or [[ceftriaxone]])
**PLUS MRSA coverage, options below depending on prevalence of CA-MRSA
**PLUS MRSA coverage, options below depending on prevalence of CA-MRSA
***Clindamycin 40 mg/kg/d IV divided q8hr
***[[Clindamycin]] 40mg/kg/d IV divided q8hr '''OR'''
***OR vancomycin 45 mg/kg/d IV divided q8hr
***[[Vancomycin]] 45mg/kg/d IV divided q8hr


== Disposition ==
==Disposition==
*ICU admit
*Admit to ICU  
*Often require prolong intubation, 4-5 days
*Often require prolonged intubation (4-5 days)
 
==Complications==
*Toxic shock syndrome
*Septic shock
*Renal failure
*Postintubation pulmonary edema
*ARDS
*Residual subglottic stenosis


==See Also==
==See Also==
*[[Stridor (Peds)]]
*[[Stridor]]


== References ==
==References==
 
<references/>


[[Category:Peds]]
[[Category:Pediatrics]]
[[Category:ID]]
[[Category:ID]]
[[Category:Pulm]]
[[Category:Pulmonary]]

Revision as of 18:53, 18 April 2018

Background

  • Bacterial infection of tracheal epithelium
  • Peak age is 3-5 years old
    • Occurs throughout childhood and adulthood

Clinical Features

  • Severely ill child, starts out as viral prodrome
  • Difficult to differentiate from croup and epiglotitis
    • Severe decompensation, high fever, purulent secretions help differentiate
    • May also have concomitant pneumonia
  • May have been treated with racemic epinephrine and steroids for croup, with no clinical improvement

Differential Diagnosis

Pediatric stridor

<6 Months Old

  • Laryngotracheomalacia
    • Accounts for 60%
    • Usually exacerbated by viral URI
    • Diagnosed with flexible fiberoptic laryngoscopy
  • Vocal cord paralysis
    • Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
    • May have cyanosis or apnea if bilateral (less common)
  • Subglottic stenosis
    • Congenital vs secondary to prolonged intubation in premies
  • Airway hemangioma
    • Usually regresses by age 5
    • Associated with skin hemangiomas in beard distribution
  • Vascular ring/sling

>6 Months Old

  • Croup
    • viral laryngotracheobronchitis
    • 6 mo - 3 yr, peaks at 2 yrs
    • Most severe on 3rd-4th day of illness
    • Steeple sign not reliable- diagnose clinically
  • Epiglottitis
    • H flu type B
      • Have higher suspicion in unvaccinated children
    • Rapid onset sore throat, fever, drooling
    • Difficult airway- call anesthesia/ ENT early
  • Bacterial tracheitis
    • Rare but causes life-threatening obstruction
    • Symptoms of croup + toxic-appearing = bacterial tracheitis
  • Foreign body (sudden onset)
    • Marked variation in quality or pattern of stridor
  • Retropharyngeal abscess
    • Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension

Evaluation

  • Clinical diagnosis
  • Gram stain with predominance of one organism, differentiating from colonization
  • XR neck may show subglottic narrowing with ragged tracheal epithelium
  • CXR may show concomitant pneumonia
  • Emergent bronchoscopy is diagnostic and therapeutic

Management

  • Intubation, emergent, usually necessary
  • Bronchoscopy to confirm diagnosis, rule out supraglottic pathology
  • Antibiotics[1]
    • Third generation cephalosporin (cefotaxime or ceftriaxone)
    • PLUS MRSA coverage, options below depending on prevalence of CA-MRSA

Disposition

  • Admit to ICU
  • Often require prolonged intubation (4-5 days)

Complications

  • Toxic shock syndrome
  • Septic shock
  • Renal failure
  • Postintubation pulmonary edema
  • ARDS
  • Residual subglottic stenosis

See Also

References

  1. Bacterial Tracheitis - Treatment and Management. Medscape. http://emedicine.medscape.com/article/961647-treatment