Tracheitis

Dominick DeBlasio; F. Joseph Real

doi:10.1542/pir.2019-0181

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Dominick DeBlasio, MD, MEd*,†
F. Joseph Real, MD, MEd*,†

^*Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
^†University of Cincinnati College of Medicine, Cincinnati, OH

AUTHOR DISCLOSURE
Drs DeBlasio and Real have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

The disease process of tracheitis is characterized by purulent tracheal secretions and pseudomembranes, which can lead to airway obstruction and subsequent respiratory failure. Although it is relatively rare (with an estimated incidence of 0.1 cases per 100,000 children), tracheitis remains a life-threatening condition that typically requires emergency evaluation and intervention. This In Brief addresses the process in both previously healthy children and those with artificial airways.

Tracheitis in Previously Healthy Children

Tracheitis, also referred to as bacterial tracheitis, exudative tracheitis, or acute bacterial laryngotracheobronchitis, is typically seen in younger children, with most cases occurring in children 6 years or younger. Tracheitis is particularly perilous for young pediatric patients given their small-caliber airways, which are more easily obstructed. The rates of tracheitis are slightly higher in males (male to female ratio is 1.3:1), with most cases occurring during the late fall and winter months, which corresponds with the seasonal pathogens during that time frame.

Tracheitis in previously healthy children most often results from a bacterial superinfection of the trachea after a viral respiratory illness. The most common preceding viral illnesses are influenza and parainfluenza. These viruses cause a mild mucosal injury to the trachea, which provides an entry for bacteria leading to a secondary infection. Common bacteria associated with tracheitis include Staphylococcus aureus (the most common), Streptococcus pyogenes, α-hemolytic streptococci, Moraxella catarrhalis, and Haemophilus influenzae.

Clinically, most patients will have a viral prodromal period (characterized by cough, coryza, and, sometimes, fever) for a few days before the onset of signs and symptoms typically associated with the bacterial infection. A typical presentation for tracheitis includes sudden onset of stridor (possibly biphasic), worsening cough, and respiratory …