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
- 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
- Antecedent viral infection, especially croup
- Tracheal trauma
- Routine childhood immunization with Haemophilus influenzae type b, influenza, measles, and pneumococcal vaccines
- Avoid overaggressive suctioning of children with artificial airways.
- 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.
- 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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