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- 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
- 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
- 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
No known genetic predisposition
- 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
- 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.