Tracheitis
Basics
DESCRIPTION
Infection of the trachea associated with airway inflammation and obstruction
- Acute tracheitis: sudden onset; higher morbidity and mortality
- Subacute tracheitis: indolent presentation and course; more common among children with prolonged intubation, tracheostomy, and/or underlying respiratory or neurologic conditions
EPIDEMIOLOGY
- Viral prodrome common
- Increased incidence during viral respiratory season (fall and winter): up to 75% coinfected with influenza A
- Gender predisposition unclear (1.3:1 male-to-female ratio has been reported.)
- 2–3% mortality rate
RISK-FACTORS
- Antecedent viral infection, especially croup
- Tracheal trauma
GENERAL-PREVENTION
- Routine childhood immunization with Haemophilus influenzae type b, influenza, measles, and pneumococcal vaccines
- Avoid overaggressive suctioning of children with artificial airways.
PATHOPHYSIOLOGY
- Epithelial damage from a viral infection or mechanical trauma (e.g., endotracheal intubation, surgical procedure) occurs in the trachea at the level of the cricoid cartilage. As a result, the damaged tissue is more susceptible to bacterial superinfection.
- Mucosal damage characterized by marked subglottic edema, copious purulent secretions, and a pseudomembrane (mucosal lining, inflammatory products, and bacteria). These changes lead to marked airway obstruction.
- Toxic shock syndrome may be a consequence if the infection is associated with toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes.
ETIOLOGY
- Bacteria
- S. aureus (most common), group A β-hemolytic Streptococcus, Moraxella catarrhalis, nontypeable H. influenzae, Streptococcus pneumoniae
- Pseudomonas aeruginosa and other gram-negative enteric bacteria have been associated with health care–associated infections.
- Mycobacterium tuberculosis, Mycoplasma pneumoniae, Corynebacterium diphtheriae, H. influenzae type b, and respiratory anaerobic bacteria are uncommon pathogens.
- Viruses: Influenza, parainfluenza, respiratory syncytial, herpes simplex, and measles viruses have been found with bacterial pathogen(s).
- Fungi: seen with underlying immunodeficiency disorders or chronic steroid use
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Citation
Cabana, Michael D., editor. "Tracheitis." Select 5-Minute Pediatrics Topics, 7th ed., Wolters Kluwer Health, 2015. Medicine Central, im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14189/all/Tracheitis.
Tracheitis. In: Cabana MDM, ed. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14189/all/Tracheitis. Accessed December 3, 2024.
Tracheitis. (2015). In Cabana, M. D. (Ed.), Select 5-Minute Pediatrics Topics (7th ed.). Wolters Kluwer Health. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14189/all/Tracheitis
Tracheitis [Internet]. In: Cabana MDM, editors. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. [cited 2024 December 03]. Available from: https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14189/all/Tracheitis.
* Article titles in AMA citation format should be in sentence-case
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