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, Department 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].
- Jones R, Santos JI, Overall JC Jr. Bacterial tracheitis. JAMA 1979; 242:721.
- Conley SF, Beste DJ, Hoffmann RG. Measles-associated bacterial tracheitis. Pediatr Infect Dis J 1993; 12:414.
- Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis 1990; 12:729.
- Salamone FN, Bobbitt DB, Myer CM, et al. Bacterial tracheitis reexamined: is there a less severe manifestation? Otolaryngol Head Neck Surg 2004; 131:871.
- Hopkins A, Lahiri T, Salerno R, Heath B. Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics 2006; 118:1418.
- Gallagher PG, Myer CM 3rd. An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. Pediatr Emerg Care 1991; 7:337.
- Hjuler IM, Hansen MB, Olsen B, Renneberg J. Bacterial colonization of the larynx and trachea in healthy children. Acta Paediatr 1995; 84:566.
- De Dooy J, Ieven M, Stevens W, et al. Endotracheal colonization at birth is associated with a pathogen-dependent pro- and antiinflammatory cytokine response in ventilated preterm infants: a prospective cohort study. Pediatr Res 2004; 56:547.
- Liston SL, Gehrz RC, Siegel LG, Tilelli J. Bacterial tracheitis. Am J Dis Child 1983; 137:764.
- Edwards KM, Dundon MC, Altemeier WA. Bacterial tracheitis as a complication of viral croup. Pediatr Infect Dis 1983; 2:390.
- Eid NS, Jones VF. Bacterial tracheitis as a complication of tonsillectomy and adenoidectomy. J Pediatr 1994; 125:401.
- Henry RL, Mellis CM, Benjamin B. Pseudomembranous croup. Arch Dis Child 1983; 58:180.
- Dudin AA, Thalji A, Rambaud-Cousson A. Bacterial tracheitis among children hospitalized for severe obstructive dyspnea. Pediatr Infect Dis J 1990; 9:293.
- Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis 1998; 27:458.
- Orton HB, Smith EL, Bell HO, Ford RA. Acute laryngotracheobronchitis. Arch Otolaryngol 1941; 33:926.
- Neffson AH. Acute laryngotracheobronchitis: a 25 year review. Am J Med Sci 1944; 208:524.
- Liston SL, Gehrz RC, Jarvis CW. Bacterial tracheitis. Arch Otolaryngol 1981; 107:561.
- Yamazaki Y, Hirai K, Honda T. Pseudomembranous tracheobronchitis caused by methicillin-resistant Staphylococcus aureus. Scand J Infect Dis 2002; 34:211.
- Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis 2009; 41:548.
- Devlin B, Golchin K, Adair R. Paediatric airway emergencies in Northern Ireland, 1990-2003. J Laryngol Otol 2007; 121:659.
- Tebruegge M, Pantazidou A, Yau C, et al. Bacterial tracheitis - tremendously rare, but truly important: A systematic review. J Pediatr Infect Dis 2009; 4:199.
- Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int 2009; 51:110.
- Dawood FS, Chaves SS, Pérez A, et al. Complications and associated bacterial coinfections among children hospitalized with seasonal or pandemic influenza, United States, 2003-2010. J Infect Dis 2014; 209:686.
- Brook I. Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care 1997; 13:16.
- Kasian GF, Bingham WT, Steinberg J, et al. Bacterial tracheitis in children. CMAJ 1989; 140:46.
- Alvarez-Uria G, Surinach JM, Ventura A, et al. Herpetic tracheitis and polybacterial pneumonia in an immunocompetent young man is herpes tracheitis involved in the pathogenesis of bacterial pneumonia? J Clin Virol 2008; 41:164.
- McCarthy DW, Qualman SJ, Rudman DT, et al. Herpetic tracheitis and brachial plexus neuropathy in a child with burns. J Burn Care Rehabil 1999; 20:377.
- Baras L, Farber CM, Van Vooren JP, Parent D. Herpes simplex virus tracheitis in a patient with the acquired immunodeficiency syndrome. Eur Respir J 1994; 7:2091.
- Nelson WE. Bacterial croup: a historical perspective. J Pediatr 1984; 105:52.
- Graf J, Stein F. Tracheitis in pediatric patients. Semin Pediatr Infect Dis 2006; 17:11.
- Surh L, Read SE. Staphylococcal tracheitis and toxic shock syndrome in a young child. J Pediatr 1984; 105:585.
- Naqvi SH, Dunkle LM. Bacterial tracheitis and viral croup. Pediatr Infect Dis 1984; 3:282.
- Han BK, Dunbar JS, Striker TW. Membranous laryngotracheobronchitis (membranous croup). AJR Am J Roentgenol 1979; 133:53.
- Friedman EM, Jorgensen K, Healy GB, McGill TJ. Bacterial tracheitis--two-year experience. Laryngoscope 1985; 95:9.
- Eckel HE, Widemann B, Damm M, Roth B. Airway endoscopy in the diagnosis and treatment of bacterial tracheitis in children. Int J Pediatr Otorhinolaryngol 1993; 27:147.
- Walner DL, Ouanounou S, Donnelly LF, Cotton RT. Utility of radiographs in the evaluation of pediatric upper airway obstruction. Ann Otol Rhinol Laryngol 1999; 108:378.
- Denneny JC 3rd, Handler SD. Membranous laryngotracheobronchitis. Pediatrics 1982; 70:705.
- Kinebuchi S, Oohashi K, Takada T, et al. Tracheo-bronchitis associated with Crohn's disease improved on inhaled corticotherapy. Intern Med 2004; 43:829.
- Rickli H, Fretz C, Hoffman M, et al. Severe inflammatory upper airway stenosis in ulcerative colitis. Eur Respir J 1994; 7:1899.
- 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