Tracheitis, Bacterial

Tracheitis, Bacterial is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Acute, potentially life-threatening infraglottic bacterial infection following a primary viral infection, usually parainfluenzae or influenza viruses
    • Direct laryngoscopy reveals marked subglottic edema and thick mucopurulent secretions, sometimes causing pseudomembranes.
  • System(s) affected: pulmonary
  • Synonym(s): laryngotracheobronchitis; pseudomembranous croup; bacterial croup

Epidemiology

Incidence
  • Estimated incidence: 4 to 8 per 1 million (1)
  • First cases described prior to 1950; resurgence of cases has been noted since 1979.
  • Peak incidence in children: fall and winter
  • Mean age: 5 years (1)
  • Infections in adolescents and adults have been reported.
  • Predominant sex: male > female (2:1)
  • Accounts for 5–14% of upper airway obstruction in children requiring critical care services

Prevalence
  • Rare illness
  • Most common potentially life-threatening upper airway infection in children
  • Methicillin-resistant Staphylococcus aureus (MRSA) may contribute to changing epidemiology and virulence.

Etiology and Pathophysiology

  • S. aureus (most common pediatric cause): Consider MRSA.
  • Haemophilus influenzae type B
  • Streptococcus pyogenes group A
  • Streptococcus pneumoniae
  • Moraxella catarrhalis (associated with higher intubation rate; more frequent in younger children)
  • Frequently polymicrobial

Genetics
No known genetic predisposition

Risk Factors

  • Periods of increased seasonal activity of respiratory viruses
  • Reports following adenoidectomy, with chronic tracheal aspiration, with evidence of other concurrent infections, including sinusitis, otitis, pneumonia, or pharyngitis

General Prevention

  • Standard precautions, with scrupulous attention to hand washing
  • Vaccination against viruses that may predispose to bacterial tracheitis
  • In children with artificial airways, periodic surveillance of tracheal cultures can be helpful.

Commonly Associated Conditions

  • Consider anatomic abnormalities or foreign body as well as recent pharyngeal or laryngeal surgery.
  • Predisposing: Down syndrome, immunodeficiency, subglottic hemangioma, tracheoesophageal fistula repair, tracheobronchomalacia
  • Viral coinfection may occur.

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Citation

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TY - ELEC T1 - Tracheitis, Bacterial ID - 116612 ED - Baldor,Robert A, ED - Domino,Frank J, 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 - 27 DB - Medicine Central DP - Unbound Medicine ER -