Tracheitis, Bacterial
Basics
Description
- Acute, life-threatening upper airway obstruction due to infraglottic bacterial infection following a primary viral infection (typically parainfluenza or influenza)
- Historically high mortality rates of up to 20% in children; more recent experience suggests changing epidemiology resulting in a more atypical presentation and variable course (1) but which can still result in severe, acute, upper airway obstruction.
- Affects two major groups of patients in the pediatric age range:
- Those with a native intact airway
- Those with an artificial airway
- Often preceded by viral infection, such as influenza, parainfluenza, or respiratory syncytial virus
- Staphylococcus aureus is the most common bacteria identified (1).
- Diagnostic hallmarks on endoscopy: ulceration, pseudomembranes in the trachea with thick mucopurulent exudates and mucosal sloughing (1)
- System(s) affected: pulmonary
- Synonym(s): laryngotracheobronchitis; bacterial croup; pseudomembranous croup
Epidemiology
Incidence
- Incidence: 4 to 8 per 1 million children
- Peak incidence in children: fall and winter
- Mean age: 5 years (2)
- Infections in adolescents and adults have been reported.
Prevalence
Methicillin-resistant Staphylococcus aureus (MRSA) may contribute to changing epidemiology and virulence.
Etiology and Pathophysiology
- Methicillin-sensitive S. aureus (MSSA) accounted for 50% cases in Casazza series (2019) (1).
- Mixed respiratory
- Streptococcus pneumoniae
- In children with artificial airway, most common organisms are S. aureus, Haemophilus influenzae, S. pneumoniae, Pseudomonas aeruginosa, and other gram-negative organisms.
- Viral-induced injury to the respiratory epithelium in conjunction with localized immune impairment can predispose individuals to bacterial superinfection.
Genetics
No known genetic predisposition
Risk Factors
- Periods of increased seasonal activity of respiratory viruses
- Reports following tonsillectomy, adenoidectomy, with chronic tracheal aspiration, and with evidence of other concurrent infections, including sinusitis, otitis, pneumonia, or pharyngitis
General Prevention
- Standard precautions, with scrupulous attention to handwashing
- Vaccination against viruses that may predispose to bacterial tracheitis
Commonly Associated Conditions
- Consider anatomic abnormalities and foreign bodies as well as recent pharyngeal or laryngeal surgery.
- Predisposing: Down syndrome, immunodeficiency, subglottic hemangioma, tracheoesophageal fistula repair, tracheobronchomalacia
- More common in children with tracheostomy
- Viral coinfection may occur.
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Citation
Domino, Frank J., et al., editors. "Tracheitis, Bacterial." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116612/all/Tracheitis__Bacterial.
Tracheitis, Bacterial. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116612/all/Tracheitis__Bacterial. Accessed October 10, 2024.
Tracheitis, Bacterial. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116612/all/Tracheitis__Bacterial
Tracheitis, Bacterial [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 10]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116612/all/Tracheitis__Bacterial.
* Article titles in AMA citation format should be in sentence-case
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T1 - Tracheitis, Bacterial
ID - 116612
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116612/all/Tracheitis__Bacterial
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
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