definition , pathophysiology,causes ,differential diagnosis ,management ,prognosis

1. Bacterial
TracheitisProf. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
Saadsalani@yahoo.com

2. Introduction
Bacterial tracheitis is an uncommon
infectious cause of acute upper airway
obstruction, BUT it is more prevalent
than acute epiglottitis
Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year
experience at a medical center in Taiwan. Pediatr Int. 2009 Feb. 51(1):110-3
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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3. Introduction (Cont.)
Patients may present with croup-like
symptoms, such as barking cough,
stridor, and fever
Holmes A. Croup: What It Is and How to Treat It. US Pharm. 2013. 38(7):47-50.
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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4. Pathophysiology
Bacterial tracheitis
Is a diffuse inflammatory process of the
larynx, trachea, and bronchi with
adherent or semi-adherent mucopurulent
membranes within the trachea.
Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct.
27(10):950-3
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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5. Pathophysiology (Cont.)
Acute airway obstruction may develop
secondary to:
• Subglottic edema and sloughing of
epithelial lining
or
• Accumulation of mucopurulent membrane
within the trachea
Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct.
27(10):950-3
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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6. Pathogenesis
• The pathogenesis??
• The factors that predispose the airway
to invasive infection with common
pyogenic organisms, include preceded:
 Viral infection
 Injury to the trachea from recent intubation
 Trauma
Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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7. Epidemiology
Bacterial tracheitis
Remains a rare condition, with an estimated
incidence of approximately 0.1 cases per
100,000 children per year
Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J
Infect Dis. 2009 Apr 28. 1-10.
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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8. Clinical Presentation
• The age: range was from 3 weeks to 16
years, with a mean age of 4 years
• The prodrome is usually an upper
respiratory infection, followed by
progression to:
- Higher fever
- Cough
- Inspiratory stridor
- Variable degree of respiratory distress
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe
manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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9. Clinical Presentation (cont.)
• The classic presentation :
-Fevers
-Toxic appearance
-Stridor
-Tachypnea
-Respiratory distress
-Cough is frequent and not painful.
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe
manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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10. Clinical Presentation (cont.)
• A high index of suspicion for
bacterial tracheitis is needed in
children with viral croup–like
symptoms who do not respond to
standard croup treatment or
clinically worsen.
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe
manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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11. Clinical Presentation (cont.)
Clinical examination:
• Inspiratory stridor (with or without
expiratory stridor)
• Bark- like or brassy cough
• Hoarseness
• Worsening or abruptly occurring stridor
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe
manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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12. Clinical Presentation (cont.)
• Varying degrees of respiratory distress:
 Retractions
 Dyspnea
 Nasal flaring
 Cyanosis
• Sore throat, odynophagia
• Dysphonia
Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe
manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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13. Causative factors
• S aureus
• S pyogenes, Streptococcus pneumoniae
• Moraxella catarrhalis
• Haemophilus influenzae type B (less
common)
• Klebsiella species
• Pseudomonas species
• Anaerobes
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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14. Causative factors(Cont.)
• Peptostreptococcus species
• Bacteroides species
• Mycoplasma pneumoniae
• Mycobacterium
tuberculosis (endobronchial disease)
• H1N1 influenza
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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15. Differential diagnosis
• Croup
• Angioedema
• Epiglottitis
• Peritonsillar abscess
• Retropharyngeal Abscess
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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16. Laboratory Investigations
In patients with suspected bacterial
tracheitis:
• bacterial culture and Gram stain of
tracheal secretions
• blood cultures
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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17. Radiography
Radiology neither definitive nor essential
May reveal :
• Subglottic narrowing on anteroposterior
(AP) views - Steeple sign, similar to croup
• Clouding of tracheal air column or
irregular tracheal margin on lateral view
• Foreign body-like due to Concretions of
epithelium and inflammatory cells
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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18. Steeple sign
https://radiopaedia.org/articles/steeple-sign-trachea
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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19. Bacterial tracheitis :
Lateral neck X-ray
https://avoidingerrors.com/2016/05/07/airway/
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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lateral neck X-ray shows intraluminal narrowing or irregulaties on trachea

20. Retropharyngeal abscess :
Lateral neck X-ray
EB Medicine/
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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21. Laryngotracheobronchoscopy
Indications
• Only definitive means of diagnosis
• May be therapeutic by performing
tracheal toilet and stripping purulent
membranes
• Direct visualization and culture of
purulent tracheal secretions
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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22. Management
• Maintenance of an adequate airway is
of primary importance
• Avoid agitating the child
• Most patients (57-100%) require
eventual intubation.
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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Gross JH, Giraldez-Rodriguez LA, Klein AM. Bacterial Laryngotracheitis and Associated Upper Airway Obstruction: A Case
Series. Ann Otol Rhinol Laryngol. 2015 Dec. 124 (12):1002-5

23. Management(Cont..)
• Third-generation cephalosporin (e.g.,
cefotaxime, ceftriaxone) and a penicillinase-
resistant penicillin (e.g., oxacillin, nafcillin).
• Vancomycin (45 mg/kg/d IV, divided every 8
h), with or without clindamycin, should be
started:
 In patients who :
o appear toxic
o have multiorgan involvement
 if MRSA is prevalent in the community.
08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani
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Gross JH, Giraldez-Rodriguez LA, Klein AM. Bacterial Laryngotracheitis and Associated Upper Airway
Obstruction: A Case Series. Ann Otol Rhinol Laryngol. 2015 Dec. 124 (12):1002-5

24. Tracheostomy
• Is rarely necessary unless injury or
trauma to the airway has caused
scarring and documented narrowing of
the airway.
08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani
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25. Complications
• Pneumonia
• Septicemia
• Toxic shock syndrome
• Anoxic encephalopathy
• Cardiorespiratory arrest
• Endotracheal tube complications
08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani
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26. Prognosis
Complete recovery is expected once the
patient is past the acute phase,
08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani
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27. References
• Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg
Care. 2011 Oct. 27(10):950-3.
• Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1.
83(9):1067-73.
• Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre
perspective. Scand J Infect Dis. 2009 Apr 28. 1-10
08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani
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28. Thank you
08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani
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