Bacterial Tracheitis

Bacterial tracheitis, also known as membranous croup or membranous laryngotracheobronchitis, is rare. It is generally caused by bacterial superinfection of an

antecedent viral upper respiratory infection. It is most commonly seen in children less than 3 years of age, with a median age of incidence at 4 2 years. Nearly all reported cases have arisen in those between 3 months and 13 years of age. Typically, 2 to 7 days of a croup-like syndrome is followed by worsening symptoms and the development of a toxic appearance over a period of several hours. Children appear septic or similar in appearance to those with epiglottitis, with a few important differences.25 As a rule, children with bacterial tracheitis have severe inspiratory and expiratory stridor, cough with occasional thick sputum production, a raspy or hoarse voice, and no dysphagia. Children with bacterial tracheitis may also complain of a gnawing or burning substernal chest discomfort.

The history, physical, laboratory, and radiologic findings may help diagnose less obvious cases in nontoxic-appearing patients. Most patients will have a markedly elevated white count with an impressive left shift. Blood cultures are typically negative. AP and lateral neck radiographs usually demonstrate subglottic narrowing of the trachea. Irregular densities may be seen within the trachea and its borders may appear ragged and indistinct.

Management is similar to that of epiglottitis. Ideally, these patients should go to the operating room for sedation, intubation, and bronchoscopy. Culture and Gram stain of the mucopurulent secretions should be obtained at this time. Gram-stain findings may help guide antibiotic therapy. In less severe cases without respiratory distress, bronchoscopy may be performed without immediate intubation. This is the exception to the rule, however, as greater than 85 percent of cases will require intubation.

Antibiotics effective against S. aureus, S. pneumoniae, and beta lactamase-producing gram-negative organisms such as H. influenzae and M. catarrhalis should be given empirically. Vancomycin and a third-generation cephalosporin, such as cefotaxime or ceftriaxone, are commonly used.

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