Tracheitis - Causes, Symptoms and Treatments

Defintion:

Tracheitis is an acute bacterial infection of the trachea that may lead to complete airway obstruction, sepsis, and death. Tracheitis occurs most commonly in children under age 3, but it can occur in children as old as age 8. Incidence of the disease is unknown, but it affects males and females equally.

Causes of Tracheitis:

Tracheitis is most often caused by Staphy­ lococcus aureus; however, other bacterial organisms such as Moraxella catarrhalis and group A betahemolytic streptococci have also been implicated. The precipitating event is almost always a recent viral upper or lower respiratory tract infection. The decreased diameter of the child's trachea relative to the amount of swelling caused by the microbe may predispose the child to severe respiratory compromise. The microbes cause inflammation at the cricoid cartilage; mucosal edema; and copious, thick, purulent secretions.

Signs and symptoms of Tracheitis:

The child will exhibit an acute onset of high fever. A cough from a prior upper respiratory tract infection may still be present, but it rapidly worsens. The croup­like cough then progresses to the high-pitched, crowing sound of inspiratory stridor, signaling impending airway obstruction. Nasal flaring and intercostal retractions appear as respiratory compromise worsens. Odynophagia typically is not present. The child displays a toxic appearance. Signs and symptoms of toxic shock/sepsis may occur secondary to S. aureus infection.

Diagnosis of Tracheitis:

Endoscopy is the best diagnostic method, permitting direct visualization of the involved structures. Endoscopic symptoms include subglottic edema, ulceration, pseudomembrane formation, and intraluminal soft tissue irregularities.

Chest X-ray reveals the characteristic "steeple sign" (pencil-shaped configuration of subglottic edema) as well as patchy infiltrates with focal densities.

Tracheal or nasopharyngeal cultures will reveal the infecting pathogen. Arterial blood gases evaluate severity of oxygen deprivation, while a complete blood count reveals moderate leukocytosis with bands.

The differential diagnosis includes epiglottitis, foreign body, subglottic stenosis, tracheobronchitis, croup, and asthma. Failure to respond to croup treatments, such as humidity and racemic epinephrine, helps to differentiate tracheitis from croup.

Treatment of Tracheitis:

Treatment consists of maintaining a patent airway and antibiotic therapy. Most patients require endotracheal intubation or tracheostomy; for those who do not, supplemental oxygen should be provided. Intravenous cefuroxime is the drug of choice and should be administered empirically while awaiting culture results. In cases of toxic shock, hemodynamic monitoring and support may be required. Extubation can usually be accomplished after 3 to 7 days of antibiotic therapy.

Special considerations and Prevention tips:

1. Monitor respiratory status closely in those patients who do not have an artificial airway via continuous pulse oximetry, ABGs, or both. Have a tracheostomy kit at the bedside.

2. Suction intubated patients vigorously; obtain sputum cultures as ordered, preferably before antibiotic administration.

3. Provide emotional support to the patient and family.

4. Administer antipyretics as needed. Aspirin is not given to children under 18 years of age.

5. Monitor complete blood counts.

6. Monitor for signs of dehydration.

7. Parents should be carefully instructed regarding signs of respiratory distress in their young children, particularly after an upper respiratory infection.

8. Stress that this is a true emergency requiring immediate medical treatment or death may quickly ensue.

9. Parents who are unsure of the severity of their child's breathing difficulties should bc encouraged to err on the side of caution and to seek immediate medical care.