PEDBASE.org - The Pediatric Database - Detailed information of BACTERIAL TRACHEITIS

BACTERIAL TRACHEITIS

DEFINITION:

An acute bacterial infection of the trachea characterized by cough and a "toxic" appearance.

EPIDEMIOLOGY:

incidence: ?
age of onset:
- most <3 yrs
risk factors:
- M = F (in incidence & severity)

PATHOGENESIS:

1. Pathogens

Staph. aureus
Moraxilla catarrhalis
Group A beta-hemolytic Streptococcus

2. Pathogenesis

usually follows a viral respiratory tract infection and may not be a primary disease but a secondary complication of a viral infection (i.e., croup, tracheobronchitis)
bacterial infection -> inflammation at the cricoid cartilage
mucosal edema and copious, thick, purulent secretions

CLINICAL FEATURES:

1. Prodrome

viral upper or lower respiratory tract infection

2. Respiratory Manifestations

high fever and toxic-looking
brassy cough +/- chest pain
inspiratory stridor of increasing severity
purulent sputum

3. Complications

respiratory distress -> acute airway obstruction
sepsis (toxic shock)

INVESTIGATIONS:

1. Serum

moderate leukocytosis with bands

2. Imaging Studies

1. Chest X-Ray

subglottic narrowing
patchy infiltrates with focal densities

2. Direct Laryngoscopy

signs of tracheal inflammation (cricoid cartilage)

3. Microbiology

samples of sputum or tracheal/endotracheal secretions
gram stain, C&S -> WBC's, organisms

MANAGEMENT:

1. Supportive

respiratory support with severe or life-threatening upper air-way obstruction, i.e., intubation, tracheostomy
vigorous suctioning
hemodynamic support
treatment for croup ineffective (humidity, racemic epinephrine)

2. Medical

1. Antibiotics

IV Cefuroxime empirically until culture and sensitivity of tracheal aspiration returned

Pediatric Database - BACTERIAL TRACHEITIS

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