Tracheobronchitis Caused by Methicillin-Resistant <i>Staphylococcus aureus</i> as a Cause of Chronic Wheezing in a Non-Ventilated Adult Patient with Tracheobronchomalacia

Abstract

Bacterial tracheobronchitis is an extremely rare entity, which was long considered to be a pediatric disease. We report the case of a 65-year-old woman who presented with persistent wheezing, worsening productive cough and sore throat. Computed tomography of the chest revealed the presence of tracheomalacia, confirmed at bronchoscopy. The presence of purulent exudate, coating the trachea and main bronchi, was consistent with bacterial tracheobronchitis. Culture of the tracheal aspirates grew methicillin-resistant Staphylococcus aureus (MRSA). As the patient was afebrile and not systemically ill, the clinical picture was consistent with exudative tracheobronchitis. To our knowledge, this is the first case of MRSA exudative tracheobronchitis and tracheomalacia in a non-ventilated adult. Other adult cases of bacterial tracheobronchitis and MRSA tracheobronchitis in mechanically ventilated patients reported in the literature are also reviewed.Physicians should be aware of the diagnosis of tracheomalacia in adults, which can masquerade as persistent asthma and may be associated with the development of serious infections including MRSA tracheobronchitis.

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

“…Methicillin-resistant Staphylococcus aureus (MRSA) strains producing cytotoxin Panton-Valentine leukocidin (PVL) are associated with an increased risk of severe soft tissue infections as well as with serious community-acquired pneumonia (CAP) [1,2,3,4]. Currently, special attention is being paid to methicillin-resistant strains of S. aureus .…”

Nodular tracheobronchitis in a patient with lymphoma: an unusual presentation of viridans streptococcal respiratory tract infection

“…Bacterial tracheobronchitis without lung parenchymal involvement is an extremely rare entity in adults, except in patients who are intubated or mechanically ventilated. Eleven cases of bacterial tracheobronchitis with microbiologic results in non‐ventilated patients have been reported in nine English journals . In the majority of cases 8/11 (72.7%), the condition was due to Staphylococcus aureus, and most cases involved the upper trachea.…”

“…Bacterial tracheobronchitis is a lower respiratory tract infection involving the tracheobronchial tree, while sparing the lung parenchyma. It rarely occurs in non‐ventilated adult patients and has been reported in just several cases . Most of cases have been diagnosed by bronchoscopy or laryngoscopy and little is known about the computed tomography (CT) finding.…”