TREATMENT AND PREVENTION OF BACTERIAL TRACHEITIS IN CHILDREN

Verrotti A. Treatment and prevention of bacterial tracheitis in children. International Journal of Infection. 2023;7(3):61-63.

A. Verrotti*

Department of Pediatrics, University of Perugia, Italy.

*Correspondence to:
Professor Alberto Verrotti,
Department of Pediatrics,
University of Perugia,
Perugia, Italy.
e-mail: alberto.verrotti@unipg.it

ABSTRACT

Bacterial tracheitis is a serious infection of the trachea primarily affecting children. The bacterial infection, which is most often caused by Staphylococcus aureus, causes subglottic edema, exudate, mucopurulent secretions, and airway obstruction and often occurs after viral damage to the upper respiratory tract. The exudate may narrow or block the airway, causing reduced oxygenation and a high-pitched, wheezing sound during inhalation. Laboratory tests, such as a complete blood count, show neutrophilic leukocytosis. In severe cases of bacterial tracheitis, the patient may require airway surgery. Treatment includes endotracheal intubation, endoscopic removal of pseudomembranes from the tracheal lumen, and broad-spectrum antibiotic therapy. In regards to antiobiotic therapy, the combination of oxacillin and ceftriaxone appears to give satisfactory results. Vaccination against Haemophilus influenzae type B and Streptococcus pneumoniae helps prevent some of the infections that precede or complicate this bacterial infection. Bacterial tracheitis requires prompt treatment to prevent serious complications that can be life-threatening.

KEYWORDS: Bacterial tracheitis, Staphylococcus aureus, pediatrics, bacteria, pathogen, infection

INTRODUCTION

Bacterial tracheitis, which is also known as bacterial laryngotracheobronchitis or pseudomembranous croup, was first described in detail by Jones et al. in 1979 (1). Bacterial tracheitis is a serious infection of the trachea primarily affecting children (2). It is a bacterial infection that causes inflammation which may lead to airway obstruction (3). This is a rare disease with a peak incidence during the fall and winter months that occurs predominantly in children between the ages of six months and eight years with a mean age of 5 years. Bacterial tracheitis is characterized by marked subglottic edema and inflammatory exudate with typical mucopurulent secretions that are responsible for the name “pseudomembranous” (4).

DISCUSSION

The most common pathogen responsible for bacterial tracheitis is Staphylococcus aureus, although many other pathogens have been isolated, including Haemophilus influenzae, beta-Haemolytic streptococcus, Pneumococcus, and Moraxella catarralis (5). These bacteria colonize damaged tracheal tissue, often following a viral upper respiratory infection, such as influenza or parainfluenza (6). The viral infection damages the tracheal mucosa, making it more susceptible to bacterial invasion (7). Transmission of the infection can be spread through respiratory droplets from coughing or sneezing and secondary bacterial infection can occur after a viral upper respiratory tract infection (8).

The immune response to the pathogens causes an inflammatory reaction of the tracheal mucosa (9).  This causes swelling, redness, and increased mucus production (10). Immune cells such as neutrophils infiltrate the site of infection, mediating the formation of pus, which may combine with mucus and necrotic tissue to form thick, crusted secretions.  In bacterial tracheitis, the inflamed mucosa becomes swollen and edematous and produces thick, purulent secretions, which contribute to narrowing of the tracheal lumen (11). The presence of thick exudates and detached tissue can further block the airway, leading to varying degrees of respiratory obstruction (12). As the tracheal lumen narrows, it becomes increasingly difficult for the child to breathe. A high-pitched, wheezing sound is often heard during inhalation, and severe obstruction can lead to inadequate oxygenation with respiratory failure (13).

The clinical presentation of bacterial tracheitis is generally more insidious than that of epiglottitis. The patient initially exhibits symptoms of a viral upper respiratory tract infection with moderate fever, cough, and stridor (14). A period of rapid deterioration follows in which the patient develops a high fever, a toxic appearance, and displays signs of airway obstruction. These patients generally have a somewhat toxic state compared to those with laryngotracheitis, and unlike those with epiglottitis, they have a cough, can lie flat, and do not have sialorrhea.

Laboratory findings suggest a neutrophilic leukocytosis in the complete blood count. Radiographically, bacterial tracheitis may be indistinguishable from laryngotracheitis, as the neck radiograph also shows a narrowing of the subglottic region (15).  In some cases, the air passing through the trachea may appear inhomogeneous because of multiple intraluminal irregularities represented by pseudomembranes detaching from the soft tissues. Patients with evidence of severe respiratory distress should be taken to the operating room, as should those with epiglottitis (16). The gold standard for the diagnosis of bacterial tracheitis is the endoscopic finding of subglottic edema with ulceration, erythema, and pseudomembrane formation in the trachea, along with a positive bacterial culture.

Treatment includes endotracheal intubation to ensure a patency of the airway, endoscopic removal of pseudomembranes from the tracheal lumen, and broad-spectrum antibiotic therapy, considering the need for coverage against Staphylococcus aureus (17) (Table I). Oxacillin and ceftriaxone are a reasonable initial combination, although definitive antibiotic coverage should be guided by culture results (18). Antibiotic treatment is usually continued for 10 to 14 days, and intubation is usually required for 3 to 7 days (19). The decision to extubate should be based on clinical improvement, as suggested by defervescence decreased airway secretions, and the development of an air leak around the endotracheal tube.

Table I. Diagnosis and Treatment of bacterial tracheitis.

Prevention includes vaccination with vaccines against Haemophilus influenzae type B and Streptococcus pneumoniae, which can help prevent some of the infections that precede or complicate bacterial tracheitis (20). Practicing good personal hygiene and avoiding close contact with infected individuals can reduce the risk of transmission.

CONCLUSIONS                                                                                                                                                                                     

Bacterial tracheitis is an infection of the trachea that primarily affects children between the ages of 3 to 8. It is a medical emergency that can develop as a complication of a viral upper respiratory infection, such as influenza or the common cold, and requires immediate treatment to prevent more serious complications that can be life-threatening. Prompt recognition and treatment of bacterial tracheitis are crucial to prevent serious complications, and empiric intravenous antibiotic therapy should be started as soon as possible.

Conflict of interest

The author declares that they have no conflict of interest.

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