Bacterial Tracheitis

Tracheitis or Bacterial tracheitis

Bacterial tracheitis is an infection of the trachea by bacteria. It is relatively uncommon with the children typically affected because of the size and shape of their airway. [1]

Epidemiology

Roughly, the incidence is 0.1 cases per 100,000 children. Males are predominantly affected in most studies. Though the disease may come about in any paediatric age, 3 weeks to 16 years is the estimated range of occurrence with 4 years old as the mean age. [2]

Causes

Staphylococcus aureus and group A β-haemolytic streptococci are the usual etiologic agent. [1] Bacterial tracheitis usually occurs following a viral infection of the upper respiratory tract. [3] Mucosal damage and immune mechanism impairment are said to predispose the patient to bacterial invasion. [2] Bacterial tracheitis may result to the development of potentially obstructing mucopurulent exudates which could be fatal. [4]

Signs and Symptoms

The following symptoms are usually noted: high fever, deep or bark like cough, difficulty of breathing with high-pitched sound. [3] Physical findings may reveal inspiratory stridor, odynophagia, dysphonia and signs of respiratory distress such as nasal flaring, cyanosis and retractions. Hence, a classic picture of a patient with bacterial tracheitis is a febrile child in respiratory distress with stridor, faster rate of breathing than usual, frequent and painless cough and whose WBC count is elevated. [2] A child diagnosed with viral croup who is non-responsive to therapy should be assessed for bacterial tracheitis. [4]

Diagnosis

After a thorough physical assessment, diagnosis can be confirmed by direct visualization of the trachea via laryngobronchoscopy. [4] Lateral x-ray may also be indicated to find irregularities in the anatomic structure of the trachea. [1] Bacterial and blood culture may also be studied. [2]

Treatment

Upon diagnosis, the patient should be started on intravenous antimicrobial agents with wide coverage. Empirical antibiotics should be aimed at the usual pathogens of bacterial tracheitis such as S.aureus, S. pneumoniaeand H. influenza. [4] Usual drugs prescribed are third-generation cephalosporinagent like ceftriaxone combined with penicillinase-resistant penicillin like nafcillin. Ensuring that the patient has adequate airway is of chief importance hence intubation might be needed. If there is significant tracheal injury, surgery might be indicated however this is rare. [2] Usual complication is bronchopneumonia but most patients adequately treated undergo complete recovery. [1]

References:

1.http://www.merckmanuals.com/professional/pediatrics/respiratory_disorders_in_neonates_infants_and_young_children/bacterial_tracheitis.html

2. http://emedicine.medscape.com/article/961647-overview#a0199

3. http://www.umm.edu/ency/article/000988.htm

4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719512/

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