Makindo Medical Notes

🧠 Acute bacterial (exudative) tracheitis is a rare but potentially life-threatening airway infection of the subglottic trachea that typically follows a viral URTI. It can rapidly progress to airway obstruction — prompt recognition and expert airway management are essential. ⚠️ It must be distinguished from croup and epiglottitis.

📘 About

• Severe bacterial infection of the trachea, often following a viral illness.
• Most common in children aged 3–8 years, but may occur in adolescents or adults.
• Mortality is now low with modern ICU care but it remains a paediatric emergency.

🦠 Microbiology

• Common bacteria: Staphylococcus aureus (MSSA/MRSA), Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae type B.
• Less common: Moraxella catarrhalis, Pseudomonas, Gram-negative bacilli, anaerobes.
• Viral trigger: Influenza, parainfluenza, or RSV often precedes bacterial invasion.

⚠️ Risk Factors

• Recent viral respiratory infection (especially influenza).
• Immunocompromised or chronically ill children.
• Tracheostomy or prior airway instrumentation.

🩺 Clinical Features

• Prodromal URTI (cough, coryza) → sudden deterioration.
• High fever and toxic appearance.
• Harsh, painful cough with thick purulent sputum.
• Stridor (often biphasic) and marked hoarseness.
• Tracheal tenderness and respiratory distress.
• Cyanosis, lethargy, and use of accessory muscles indicate impending airway failure.

💡 Clue: Drooling and tripod posture are uncommon in tracheitis — if present, think epiglottitis.

🔍 Differentiating Airway Infections

🧪 Investigations

• Blood tests: raised WCC, CRP.
• Microbiology: Blood cultures; tracheal aspirates if intubated.
• Imaging: Neck X-ray may show “candle-wax dripping” sign (irregular tracheal mucosa). ⚠️ Do not delay airway intervention for imaging.
• Bronchoscopy: diagnostic — reveals inflamed trachea with thick exudate or pseudomembrane.

💊 Management

• Airway first: Secure by experienced anaesthetist ± ENT surgeon in theatre or ICU. 💨 40–100% of children require intubation.
• Supportive: Humidified oxygen, suctioning of secretions, IV fluids.
• Racemic adrenaline: may provide temporary relief but less effective than in croup.
• Empirical IV antibiotics:
  • Cefotaxime or ceftriaxone PLUS flucloxacillin (or vancomycin if MRSA suspected).
  • Clindamycin if toxin-producing staphylococci suspected.
• Steroids: Generally not effective (contrast with croup).
• Antivirals: Consider oseltamivir if influenza-associated.

⚡ Complications

• Acute airway obstruction
• Pneumonia or aspiration
• ARDS and respiratory failure
• Septic shock and cardiac arrest (late)

📚 References

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

🧠 Teaching tip: Think of bacterial tracheitis when a “croup-like” child becomes rapidly worse or fails to respond to nebulised adrenaline. It’s toxic, exudative, and dangerous — airway control saves lives.