Makindo Medical Notes

Related Subjects: |Acute Epiglottitis |Croup |Acute Tracheitis |Stridor

About

• Bacterial (exudative) tracheitis
• Bacterial +/- a post-viral respiratory infection complication.

Microbiology

• 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

Aetiology

• Potentially lethal infection of the subglottic trachea
• Post viral bacterial infection

Risks

• Immunocompromised more at risk

Clinical

• 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

Investigations

• ↑ 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

Pathology

• Tracheal mucosa causes 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

Complications

• ARDS, Aspiration pneumonia, Cardiac arrest
• Death, DIC, Pneumonia, Septic shock

Management

• 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

References

• Acute Tracheitis