Bacterial tracheitis

Background

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

Diagnosis

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

Workup

1. Clinical diagnosis
2. XR neck may show subglottic narrowing with ragged tracheal epithelium
3. CXR may show concominant pneumonia
4. Emergent bronchoscopy is diagnostic and therapeutic

Treatment

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

Disposition

1. ICU admit
2. Often require prolong intubation, 4-5 days

Source

Rosen