What is Tracheitis?

Child with a cough holding a bear.
Child with a cough holding a bear. Kin Images/Getty Images

Tracheitis

Also known as: tracheobronchitis, bacterial croup, laryngotracheobronchitis

Tracheitis is an infection of the trachea (breathing tube or windpipe) that is most often caused by the bacteria. The most common bacteria involved include: Staphylococcus aeureusStreptococcus pneumoniae, and Pseudomonas aeruginosa. Tracheitis most frequently occurs in small children, and can make it very difficult to breathe.

Predisposing factors include:

  • prior viral infection that affects the upper airways
  • most commonly occurs before the age of 3 (but can occur up to about age of 13)
  • measles
  • Down syndrome

Tracheitis is rare only occurring in about 1 in 1,000,000 cases and is suspected to be more prevalent in boys than girls. Because it is so rare, when this disease is present, it is commonly mistaken for viral croup, which is much more prevalent in your community. We will discuss some of the similarities and some of the differences, because tracheitis is much more deadly and commonly requires your child to receive breathing support when it is a true case of tracheitis.

Symptoms Associated With Tracheitis

Symptoms of tracheitis vary from person to person, but they can include:

  • cough that sounds "croupy" and they may cough up secretions
  • breathing difficulties
  • stridor when breathing in (common)
  • wheezing when breathing out (uncommon)
  • high fever; usually greater than 102°F or 39°C
  • blue lips (sign of cyanosis or low oxygen levels), if ability to breath is deteriorating

A "croupy cough" is a hallmark symptom for viral croup. It is often described as "barking", "brassy", or resembling a seal's bark. This can also be present in tracheitis which is why it is commonly confused with the more prevalent viral croup.

Differences Between Symptoms of Tracheitis and Croup

While the cough may sound very similar between tracheitis and viral croup, there are several features which can be used to help distinguish between the two disorders.Often, viral croup will have a progressively worsening onset, while tracheitis symptoms occur quickly. The fever can sometimes be different, with viral croup being associated with a lower fever than tracheitis; rarely being higher than 39°C. The high fever is usually what drives people to the emergency department.

The standard treatment for viral croup, humidified oxygen and inhale epinephrine (racemic epi),  can also be used to differentiate tracheitis. True tracheitis will not respond to these therapies, and sometimes has been noted to worsen the condition. If you notice that your child is getting worse while receiving these treatments, you should alert the nurse or physician.

Diagnosing Tracheitis

A tracheitis diagnosis can be based on symptoms, as well as patient history and examination.

Diagnostic tests that may be preformed by your health care provider include:

  • the measurement of oxygen levels in the blood (pulse oximetry)
  • a culture from the trachea, collected during a laryngoscopy
  • an x-ray of the lungs and breathing passageways

During these procedures, your doctor will be using the findings to help differentiate from epiglottitis another relatively rare disorder that may require rescue interventions for breathing.

Treating Tracheitis

Aggressive treatment early on is important in properly managing tracheitis. During a laryngoscopy, your physician will clear as much of the airway as possible, as there will likely be secretions and membranes that can cause airway obstruction. Initial management will usually require admission into an intensive care unit where your child can be observed and intubated (breathing tube placed) if necessary. Having a breathing tube will also allow the ICU nurses to perform aggressive airway suctioning to keep your child breathing as comfortably as possible.

Antibiotic treatment for bacterial infection is also necessary. Commonly the antibiotics of choice include IV ceftriaxone and IV vancomycin. If cultures come back resistant to these antibiotics, your child's regimen will be changed. IV antibiotics will continue for 5 to 6 days at which point you can be switched over to oral antibiotics. The total course of antibiotics will range between 1 and 2 weeks.

Source:

Ferri, F.F. (2016). Tracheitis. Ferri's Clinical Advisor 2016. Accessed on May 30, 2016 from http://www.clinicalkey.com (Subscription Required)

Rajan, S. & Steele, R.W. (2015). Bacterial Tracheitis. Accessed on May 30, 2016 from http://emedicine.medscape.com/article/961647-overview

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