Bacterial Tracheitis

Girish D. Sharma, MD, FCCP

Introduction/Etiology/Epidemiology

•Bacterial tracheitis—also referred to as membranous croup or laryngotracheobronchitis (LTB), bacterial croup, pseudomembranous croup, and nondiphtheritic laryngitis with marked exudate—is a serious and potentially life-threatening cause of upper-airway obstruction.

•The most common causative pathogen is Staphylococcus aureus; other organisms implicated are pneumococcus, Moraxella catarrhalis, and, occasionally, gram-negative enteric organisms and Pseudomonas aeruginosa.

•Since the decline in the incidence of epiglottitis and viral croup (associated with the use of the Haemophilus influenzae type b, or Hib, vaccine and nebulized and systemic corticosteroids, respectively), bacterial tracheitis has become a more common cause of upper-airway obstruction in children >2 years of age. However, bacterial tracheitis is still a rare disease.

•Reported incidence in children with an artificial airway is 0.67 (95% confidence interval, 0.59–0.81) and 5%–14% in patients with upper-airway obstruction who require intensive care.

•Bacterial tracheitis generally affects children between 4 weeks and 13 years of age, with a mean age of 5 years.

•Although it may be a primary bacterial infection, bacterial tracheitis is considered secondary to viral LTB.

•Tracheal mucosal injury caused by viral infection and impaired local immunity predisposes a child to bacterial superinfection.

•Bacterial tracheitis is characterized by marked subglottic edema, with ulceration, erythema, pseudomembranous formation on the tracheal surface, and thick, mucopurulent tracheal secretions.

•There is no seasonal variation.