Tracheitis

Bacterial tracheitis may occur at any age. In the early phase, patients may present similarly to croup however there is a failure to respond or only transient response to steroids/nebulised adrenaline and the condition worsens.

In this condition, the larynx, trachea and bronchi can become obstructed with purulent debris. There is an adherent pseudomembrane that forms over the tracheal mucosa that can slough off causing an obstruction. There is normally a preceding upper respiratory tract infection for a couple of days, followed by a rapid deterioration with a pyrexia and respiratory distress. There is a cough producing copious secretions and retrosternal pain. There is no dysphagia or drooling – unlike epiglottitis.

Causative organisms

The most common causative organisms are:

• Staphylococcus aureus (41%)
• Haemophilus influenzae (18%)
• Streptococcus pneumoniae (15%)
• Moraxella catarrhalis (13%)
• Streptococcus pyogenes (9%).

Treatment

Treatment is with intravenous antibiotics.

Endotracheal intubation is often needed for airway  control, management of respiratory failure and pulmonary toilet.

Young children can deteriorate quickly due to the smaller size of the airway. Full recovery with no long-term morbidity is expected in the vast majority of children.

The mean length of stay in hospital varies with reports between three and 12 days.

Complications

The most frequent complication associated with the acute phase of illness is pneumonia.

• Less common complications include
• Acute respiratory distress syndrome
• Septic shock
• Pulmonary oedema
• Pneumothorax
• Cardiorespiratory arrest (rarely)

Long-term morbidity associated with bacterial tracheitis is minimal. As treatment in the acute phase of the illness frequently requires insertion of an endotracheal tube into an inflamed airway, the potential for the subsequent development of subglottic stenosis is well recognised. [39]