Bacterial tracheitis

This is a purulent bacterial inflammation of the trachea with a tendency to form pablum, most commonly in children aged 6 months to 12 years. The etiologies are Staphylococcus aureus, Haemophilus influenzae and Streptococcus pneumoniae.

The formation of pablons occurs on devastated, heavily soaked mucous membranes of the upper respiratory tract. Some authors suggest that bacterial tracheitis is actually a bacterial superinfection following viral respiratory infection (most commonly parainfluenza). Involvement of the respiratory epithelium is a sufficient predisposition to bacterial superinfection.

Clinic
Initially, patients present with a picture of upper respiratory tract infection lasting several hours to days. Gradually, inspiratory dyspnea develops, but usually, with bland stridor, cough is barking to tracheal, sore throat is inconstant, voice is hoarse but dysphagia is absent. At the same time, there is an onset of alteration of the general condition (clinically a picture of toxic, non-improving laryngitis). The auditory findings are poor, bronchitic phenomena can be found.

Clinically, the disease most closely resembles acute laryngotracheobronchitis, but the onset of bacterial tracheitis is not as abrupt as in subglottic laryngitis, alteration of the general condition is usually present, the fever is usually higher. Furthermore, there is no association with the season of acute viral respiratory disease and there is a poor response to adrenaline and corticosteroid therapy.

Therapy
Because of severe upper airway obstruction and alteration of general condition, we almost always resort to intubation and UPV. After intubation, we immediately collect samples for the microbiological examination of tracheal secretions. On bronchoscopy, we find normal supraglottic structures, subglottic edema and purulent secretions in the trachea. As part of a comprehensive diagnostic workup, we perform a chest X-ray to exclude infection at other airway sites (pneumonia) and to verify the position of the tracheal tube.

In addition to UPV, we administer general antibiotics - potentiated aminopenicillins or cephalosporins of the third generation, steroids have a questionable effect.

Complications
The most common complication of bacterial tracheitis is pneumonia, followed by sepsis and ARDS.

Related articles

 * Respiratory Infection Agents
 * Staphylococcus aureus
 * Haemophilus influenzae
 * Streptococcus pneumoniae

Source

 * HAVRÁNEK, Jiří: Infekce horních dýchacích cest.