Bacterial tracheitis in children: Approach to diagnosis and treatment

Al-Mutairi, Bandar; Kirk, Valerie

doi:10.1093/pch/9.1.25

Cited by 29 publications

(22 citation statements)

References 20 publications

(101 reference statements)

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“…Need for endotracheal intubation has been reported to be between 38 and 100 % [13]. Choice of IV antibiotics is usually a combination of 3rd generation cephalosporin (e.g., Ceftriaxone, Cefotaxime) and antistaphylococcal penicillin (e.g., Cloxacillin) for 10-14 d [14].…”

Section: Bacterial Tracheitismentioning

confidence: 99%

Upper Airway Obstruction in Children

2015

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Children with upper airway obstruction are both unique and variable in their presentation and management, often posing a challenge to the pediatrician. Several anatomical and physiologic peculiarities make a child vulnerable to develop an obstruction of upper airways. The characteristic finding in upper airway obstruction is stridor-inspiratory, biphasic or expiratory. The etiologies vary widely throughout the age groups and according to the mode of presentation. The approach starts with suspicion, mandates careful clinical evaluation of the degree of obstruction and many a times emergency measures precede any investigation or even precise diagnosis. Maintaining an open and stable airway is of the utmost importance, often requiring a team approach of emergency physician, pediatrician, otorhinolaryngologist and pediatric pulmonologist. The commonest condition presenting with upper airway obstruction in pediatric population is viral croup. Croup is a clinical diagnosis in a febrile child, with barking cough and stridor preceded by upper respiratory infection. It is treated with systemic or inhaled steroids and nebulized epinephrine. Epiglottitis and bacterial tracheitis are acute bacterial infections of upper airways, presenting as true airway emergencies. Though the mainstay of therapy is IV antibiotics, the prime concern is maintenance of airway, which frequently requires endotracheal intubation. Rigid bronchoscopy is the procedure of choice for airway foreign bodies, a common cause of upper airway obstruction in children below 3 y of age. Airway malacias are the commonest cause of chronic stridor and are mostly managed conservatively.

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Section: Bacterial Tracheitismentioning

confidence: 99%

Upper Airway Obstruction in Children

2015

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“…Children with bacterial tracheitis will generally appear more toxic than children with croup and will be less likely to respond to conventional therapies such as racemic epinephrine. 2,4,5 Common presenting symptoms of bacterial tracheitis include inspiratory or expiratory stridor (85%), fever (89%), and cough (94%). 2 Laboratory evaluation may reveal either leukocytosis or leukopenia, but bandemia is common.…”

Section: Discussionmentioning

confidence: 99%

“…2 Laboratory evaluation may reveal either leukocytosis or leukopenia, but bandemia is common. 2,4,5 Lateral neck radiographs may demonstrate ragged tracheal contours, but these will not be present in all cases. 6 Direct visualization by bronchoscopy is the definitive diagnostic test for bacterial tracheitis and will demonstrate erythematous, swollen subglottic tissues with thick, mucopurulent exudate.…”

Section: Discussionmentioning

confidence: 99%

“…6 Direct visualization by bronchoscopy is the definitive diagnostic test for bacterial tracheitis and will demonstrate erythematous, swollen subglottic tissues with thick, mucopurulent exudate. 2,4 Bacterial tracheitis appears to be most common among infants and toddlers (0 -6 y of age), but has been reported in all age groups. Consistent with its frequent post-viral etiology, the peak incidence correlates with winter viruses such as influenza, parainfluenza, and respiratory syncytial virus.…”

Section: Discussionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation for Refractory Air Leak in a Child Presenting With Bacterial Tracheitis

et al. 2014

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“…The clinical effects of epinephrine in acute airway obstruction are believed to be the result of the drug’s α and β adrenergic effect, which leads to the reduction in respiratory secretions and respiratory mucosa oedema, the relaxation of airway smooth muscle and inhibition of the inflammatory process 3. Previously published research has stated that the clinical response to epinephrine is a clear discriminatory factor in enabling differentiation between croup and its rarer differentials 4 5. However, a case series by Berstein et al showed that 50% of patients with BT (6 out of 12) actually responded to nebulised epinephrine 6…”

Section: Discussionmentioning

confidence: 99%

Never trust a croup...

Nickinson

Minhas²,

Bhalla³

et al. 2011

Case Reports

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A 2-year-old girl presented to the James Paget University Hospitals Trust with croup-like symptoms and was later discharged with dexamethasone syrup. The patient re-presented 6 h later following maternal concern with signs of acute respiratory distress. After a period of clinical stability, she acutely decompensated without any prior signs of a life-threatening deterioration. She was managed using nebulised epinephrine and showed signs of clinical improvement. Although improvement persisted, the child showed signs of exhaustion following the preceding events and was later intubed with an endotracheal tube and transferred to the paediatric intensive care unit at Addenbrooke's University Hospital, Cambridge. Endotracheal aspiration later grew parainfluenza virus, rhinovirus and Staphylococcus aureus and the patient was diagnosed with the exceptionally rare life threatening complications of croup, bacterial tracheitis. The patient was discharged from intensive care 7 days later and has since made a full recovery.

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Bacterial tracheitis in children: Approach to diagnosis and treatment

Cited by 29 publications

References 20 publications

Upper Airway Obstruction in Children

Upper Airway Obstruction in Children

Extracorporeal Membrane Oxygenation for Refractory Air Leak in a Child Presenting With Bacterial Tracheitis

Never trust a croup...

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