Makindo Medical Notes

Related Subjects: |Acute Epiglottitis |Croup |Acute Tracheitis |Stridor

Acute bacterial (exudative) tracheitis is a rare but life-threatening infection of the subglottic trachea, usually following a viral URTI. It must be distinguished from croup and epiglottitis, as airway obstruction can develop rapidly and intubation is frequently required.

About

• Severe bacterial infection of the trachea, typically after a viral prodrome.
• Most common in children aged 3–8 years but can occur up to adolescence.
• Mortality is now low with modern airway management but remains a paediatric emergency.

Microbiology

• Common bacteria: Staphylococcus aureus (MSSA/MRSA), Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae type B.
• Less common: Moraxella catarrhalis, Pseudomonas, Gram-negatives, anaerobes.
• Viral prodrome: Often triggered by influenza, RSV, or parainfluenza.

Risks

• Post-viral infection (e.g. influenza).
• Immunocompromised children at higher risk.

Clinical Features

• Viral prodrome (coryza, cough, low-grade fever) → then sudden deterioration.
• High fever, toxic appearance, painful cough.
• Stridor (often biphasic) and marked hoarseness.
• Thick mucopurulent secretions, tracheal tenderness.
• Cyanosis, lethargy → suggest hypoxaemia/hypercarbia.

Drooling and tripod position are uncommon in tracheitis and suggest epiglottitis.

Comparison Table

Investigations

• Bloods: ↑WCC, ↑CRP.
• Microbiology: Blood cultures; tracheal aspirates if intubated.
• Imaging: Neck X-ray may show subglottic narrowing or “candle-wax” dripping sign, but do not delay airway management.
• Bronchoscopy: Shows erythematous trachea with thick exudates and pseudomembranes (diagnostic).

Management

• Airway: ABCs first. Intubation in theatre/ICU by senior anaesthetist ± ENT (40–100% require intubation).
• Supportive: Humidified oxygen; suctioning secretions. Racemic adrenaline may be trialled but is less effective than in croup.
• Antibiotics (IV, broad spectrum):
  • Cefotaxime or ceftriaxone PLUS flucloxacillin/vancomycin (if MRSA suspected).
  • Clindamycin can be used if toxin-producing staphylococci suspected.
• Steroids: Not routinely effective (contrast with croup).
• Antivirals: Consider oseltamivir if influenza-associated.

Complications

• Airway obstruction
• ARDS, pneumonia, aspiration
• Septic shock, cardiac arrest

References

• RCPCH: Epiglottitis & Bacterial Tracheitis
• NCBI Bookshelf: Acute Tracheitis