- Bacterial (exudative) tracheitis
- Bacterial +/- a post-viral respiratory infection complication.
- Influenza A and B (type A > B), RSV, parainfluenza, measles, enterovirus
- Bacterial: Staphylococcus aureus (MRSA/MSSA), Strep pneumoniae, Strep pyogenes, Moraxella catarrhalis, Haem influenzae type B (HiB),
- Less common:Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, and anaerobic organisms
- Potentially lethal infection of the subglottic trachea
- Post viral bacterial infection
- Immunocompromised more at risk
- Children usually under 6 years
- Rhinorrhea, post-nasal drip, cough, fever, myalgia, and sore throat
- Acute airway deterioration, high fevers, hoarseness, toxic appearance
- Increased mucopurulent secretions secondary to the bacterial infection
- Stridor (inspiratory or expiratory), fever, productive and painful cough
- Thick secretions, and tenderness of the trachea
- Cyanosis, lethargic, suggesting hypoxemia and/or hypercarbia.
Drooling and tripoding are less common and suggest an alternative diagnosis such as epiglottitis
- ↑ WCC ↑ CRP ↑ ESR
- Blood cultures
- X Ray: lateral or AP neck can show subglottic or tracheal narrowing, typical of that seen with croup (steeple sign). Also "candle dripping" sign. Epiglottis should appear normal.
- Laryngoscopy and bronchoscopy allow visualization of the infected airway and will demonstrate a normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates
- Tracheal mucosa cause oedema, thick mucopurulent secretions, ulceration, and mucosal sloughing, which can predispose the patient to subglottic narrowing, tracheal narrowing, and/or airway obstruction.
- Infection of the tracheal mucosa causes local inflammation, swelling, thick exudates, pseudomembranes, and necrosis of the larynx, trachea, and mainstem bronchi
- ARDS, Aspiration pneumonia, Cardiac arrest
- Death, DIC, Pneumonia, Septic shock
- ABC is key. Intubation is common in about 40-100%
- Humidified oxygen, racemic epinephrine trial, heliox
- Antibiotics: amoxicillin-clavulanic acid, ceftriaxone plus nafcillin or vancomycin, clindamycin plus a third-generation cephalosporin
- Steroids: do not appear to help
- Antiviral therapy may be beneficial if a preceding viral etiology is determined to be influenza