Bacterial tracheitis (pseudomembranous croup)

Bacterial tracheitis (pseudomembranous croup) is a bacterial infectious disease localized in the trachea.

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What causes bacterial tracheitis?

Bacterial tracheitis is a rare disease that occurs in children of all ages. The most common bacteria that cause tracheitis are Staphylococcus aureus, group A premolytic streptococcus, and Haemophilus influenzae type b.

Symptoms of bacterial tracheitis

Tracheitis begins acutely and is characterized by stridor, high fever, and often copious purulent discharge. As in patients with epiglottitis, the child may experience severe intoxication and respiratory failure, which may progress rapidly and require tracheal intubation.

Diagnosis of bacterial tracheitis

The diagnosis is suggested clinically and confirmed by direct laryngoscopy, which reveals the presence of purulent discharge and inflammation in the subpharyngeal region with a rough, purulent film, or by radiography of the neck in the lateral projection, which reveals a narrowing of the subpharyngeal region, which may be uneven, in contrast to the symmetrical conical narrowing characteristic of croup.

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Treatment of bacterial tracheitis

Treatment of severe tracheitis is the same as that for epiglottitis; tracheal intubation should be performed if possible. Tracheal intubation should be performed in a controlled setting by someone experienced in paediatric airway management. The initial antibiotic should be effective against S. aureus, streptococci, and H. influenzae type b; cefuroxime or equivalent intravenous antibiotic may be used empirically, although vancomycin should be used if methicillin-resistant staphylococci are prevalent in the area. Treatment of tracheitis in critically ill children should be guided by a consultant knowledgeable about local antimicrobial susceptibility patterns. Once the causative organism is known, the spectrum of coverage is narrowed and treatment is continued for 10 days or longer.

What is the prognosis for bacterial tracheitis?

Complications of tracheitis include bronchopneumonia, sepsis, and retropharyngeal cellulitis or retropharyngeal abscess. Secondary subpharyngeal stenosis associated with prolonged tracheal intubation is rare. Most children with appropriately treated tracheitis do not have any sequelae.