Bacterial tracheitis in children: Clinical features and diagnosis
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
- Section Editors
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Departments of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
The clinical features and diagnosis of bacterial tracheitis in children will be reviewed here. The treatment of bacterial tracheitis and tracheal infections associated with tracheostomy tubes and endotracheal intubation in children are discussed separately. (See "Bacterial tracheitis in children: Treatment and prevention" and "Tracheobronchitis associated with tracheostomy tubes and endotracheal intubation in children".)
Bacterial tracheitis is an invasive exudative bacterial infection of the soft tissues of the trachea (picture 1) . In some cases, there is involvement of the subglottic laryngeal structures, extension into the upper bronchial tree, or associated pneumonia [2-5]. Thus, "acute bacterial laryngotracheobronchitis" may be a more accurate clinical and anatomic description of this entity, but "bacterial tracheitis" is the preferred terminology in most textbooks and publications. (See 'Pathogenesis and pathology' below.)
Other terms that have been used to describe invasive exudative bacterial infection of soft tissues of the trachea include "bacterial croup", "membranous croup", "pseudomembranous croup", "acute laryngotracheobronchitis", and "membranous laryngotracheobronchitis" .
PATHOGENESIS AND PATHOLOGY
The larynx of healthy individuals is often colonized with bacterial species common to the upper respiratory tract, some of which are potential pathogens (eg, Staphylococcus aureus, Streptococcus pneumoniae, gram-negative enteric bacteria, Pseudomonas aeruginosa). Such colonization can extend, at least transiently, into the trachea . Bacterial colonization of the trachea may be present within 24 hours after birth, even in infants born at <31 weeks' gestation .
Bacterial tracheitis almost always occurs in the setting of prior airway mucosal damage, as occurs with antecedent viral infection [9,10] (see 'Predisposing viruses' below). Aspiration of bacteria-laden secretions into the trachea during bacterial infection of the upper respiratory tract (eg, acute bacterial sinusitis, streptococcal pharyngitis) or after tonsillectomy also may lead to bacterial tracheitis [9,11].
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- PATHOGENESIS AND PATHOLOGY
- Bacterial isolates
- Predisposing viruses
- No artificial airway
- Artificial airway
- CLINICAL FEATURES
- Airway obstruction
- Symptoms and signs
- Radiographic features
- Laboratory features
- - Indications
- - Findings
- Etiologic diagnosis
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS