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{{Tracheitis}}
{{Tracheitis}}
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{{CMG}} ; {{AE}} [[User:Dushka|Dushka Riaz, MD]]
==Overview==
==Overview==
[[Tracheitis]] is a [[bacterial infection]] of the [[trachea]]. It results in [[airway]] [[inflammation]] with [[mucosal]] [[edema]], [[Trachea|tracheal]] [[ulceration]] and thick membranous [[Exudate|exudates]]. It is most commonly caused by a superimposed [[bacterial infection]] following a [[viral]] [[upper respiratory tract infection]]. Common [[bacterial]] [[pathogens]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Haemophilus Influenzae B|Haemophilus Influenza]], [[Streptococcus Group A|Streptococcus Viridans]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. It is a disease most commonly encountered in [[pediatric]] age group, between 2-10 years of age. However, [[mechanical ventilation]] can also cause [[tracheitis]] as it allows colonization of the [[trachea]] through [[Endotracheal tube|endotracheal]] [[Endotracheal intubation|tube]].  Clinical features include [[cough]], [[Hoarseness|hoarseness,]] [[stridor]] which can rapidly progress into [[respiratory distress]] within 36 to 72 hours. Acute [[airway obstruction]] can also develop due to rapid formation of tracheal [[Exudate|exudates]]. Securing airway by [[endotracheal intubation]] is therefore crucial in management of [[tracheitis]] along with early initiation of [[Antibiotics|empiric antibiotics]]. Rigid [[endoscopy]] is performed to remove thick membranous [[Exudate|exudates]], known to cause significant tracheal lumen obstruction. Complications of [[tracheitis]] include [[airway obstruction]], [[acute respiratory distress syndrome]], [[toxic shock syndrome]], [[septic shock]] and multi organ failure.
[[Tracheitis]] is the [[bacterial infection]] of the [[trachea]]. It is also known as bacterial [[croup]] or acute [[laryngotracheobronchitis]]. It results in [[airway]] [[inflammation]] with [[mucosal]] [[edema]], [[Trachea|tracheal]] [[ulceration]] and thick membranous [[Exudate|exudates]]. It is most commonly caused by a superimposed [[bacterial infection]] following a [[viral]] [[upper respiratory tract infection]]. Common [[bacterial]] [[pathogens]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Haemophilus Influenzae B|Haemophilus Influenza]], [[Streptococcus Group A|Streptococcus Viridans]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. It is a disease most commonly encountered in the [[pediatric]] age group, between 2-10 years of age. However, [[mechanical ventilation]] can also cause [[tracheitis]] as it allows colonization of the [[trachea]] through [[Endotracheal tube|endotracheal]] [[Endotracheal intubation|tube]].  Clinical features include [[cough]], [[Hoarseness|hoarseness,]] [[stridor]] which can rapidly progress into [[respiratory distress]] within 36 to 72 hours. Acute [[airway obstruction]] can also develop due to rapid formation of tracheal [[Exudate|exudates]]. Securing [[airway]] by [[endotracheal intubation]] is therefore crucial in management of [[tracheitis]] along with early initiation of [[Antibiotics|empiric antibiotics]]. Rigid [[endoscopy]] is performed to remove thick membranous [[Exudate|exudates]], known to cause significant tracheal lumen [[obstruction]]. Complications of [[tracheitis]] include [[airway obstruction]], [[acute respiratory distress syndrome]], [[toxic shock syndrome]], [[septic shock]] and [[Multiorgan failure|multi organ failure]]. <ref name="pmid29262085">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume= | issue= | pages= | pmid=29262085 | doi= | pmc= | url= }} </ref> <ref name="pmid28757125">{{cite journal| author=Blot M, Bonniaud-Blot P, Favrolt N, Bonniaud P, Chavanet P, Piroth L| title=Update on childhood and adult infectious tracheitis. | journal=Med Mal Infect | year= 2017 | volume= 47 | issue= 7 | pages= 443-452 | pmid=28757125 | doi=10.1016/j.medmal.2017.06.006 | pmc=7125831 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28757125  }} </ref> <ref name="pmid379379">{{cite journal| author=Jones R, Santos JI, Overall JC| title=Bacterial tracheitis. | journal=JAMA | year= 1979 | volume= 242 | issue= 8 | pages= 721-6 | pmid=379379 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=379379  }} </ref> <ref name="pmid17015531">{{cite journal| author=Hopkins A, Lahiri T, Salerno R, Heath B| title=Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. | journal=Pediatrics | year= 2006 | volume= 118 | issue= 4 | pages= 1418-21 | pmid=17015531 | doi=10.1542/peds.2006-0692 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17015531  }} </ref> <ref name="pmid1788120">{{cite journal| author=Gallagher PG, Myer CM| title=An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children. | journal=Pediatr Emerg Care | year= 1991 | volume= 7 | issue= 6 | pages= 337-42 | pmid=1788120 | doi=10.1097/00006565-199112000-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1788120  }} </ref>
 
==Causes==
[[Bacterial tracheitis]] is most often caused by the [[bacteria]] [[Staphylococcus aureus]]. It frequently follows a recent [[viral]] [[upper respiratory infection]]. Common causes include [[Staphylococcus aureus|Staphylococcus Aureus]]<ref name="pmid10">{{cite journal |vauthors=Schmoldt A, Benthe HF, Haberland G, Nissenbaum A, Kenyon DH, Oro J, Worathumrong N, Grimes AJ, Lefkowitz RJ, Cannon JG, O'Donnell JP, Lee T, Hoppin CR, Long JP, Ilhan M, Costall B, Naylor RJ |title=Digitoxin metabolism by rat liver microsomes |journal=Biochem. Pharmacol. |volume=24 |issue=17 |pages=1639–41 |date=September 1975 |pmid=10 |doi=10.1007/BF01794634 |url=}}</ref><ref name="DonnellyMcMillan1990">{{cite journal|last1=Donnelly|first1=B. W.|last2=McMillan|first2=J. A.|last3=Weiner|first3=L. B.|title=Bacterial Tracheitis: Report of Eight New Cases and Review|journal=Clinical Infectious Diseases|volume=12|issue=5|year=1990|pages=729–735|issn=1058-4838|doi=10.1093/clinids/164.5.729}}</ref>
[[Streptococcus Group A|Streptococcus Pyogenes]], [[Haemophilus Influenzae B|Haemophilus Influenza]], [[Moraxella|Moraxella Catarrhalis]], [[Mycoplasma pneumonia|Mycoplasma Pneumonia]], [[Echovirus|Echoviruses,]] [[Klebsiella|Klebsiella Pneumonia,]] [[Adenoviridae|Adenovirus]], [[Rhinovirus]], Coxsakievirus and [[Influenza]] virus.
 
==Risk Factors==
 
Common risk factors in the development of [[tracheitis]] include [[pediatric]] age group, [[Virus|viral]] [[upper respiratory]] tract [[Infection|infection,]] [[mechanical ventilation]] and [[immunocompromised]] state. The individuals most likely to be affected are between 2-10 years of age. [[Staphylococcus aureus|Staphylococcus Aureus]] is the most commonly cultured [[Organisms|organism]] on [[Trachea|tracheal aspirate.]] Mechanical ventilation allows easy [[colonization]] of the [[trachea]] by [[bacteria]] and cause [[tracheitis]]. Invasive [[fungal]] [[infections]] commonly develop among [[Immunocompromised|immunocompromised i]]<nowiki/>ndividuals and can cause [[Tracheitis|tracheitis.]]
 
==Diagnosis==
===Physical Examination===
Physical examination of patients with [[tracheitis]] is usually remarkable for [[stridor]], [[tracheal]] [[tenderness]], and intercostal retractions. The may appear [[toxic]], [[lethargic]] and in respiratory distress. Coarse [[crackles]] can be heard on auscultation of the [[chest]], signifying underlying [[pneumonia]].
 
==Treatment==
===Medical Therapy===
Treatment of [[tracheitis]] involves prompt intiation of [[Antibiotic|antibiotics]] and clinical assessment of [[airway]]. Signs of impending [[respiratory failure]] include i[[Intercostal|ntercostal]] [[Retraction|retractions]], [[Cyanosis|cyanosis,]] [[lethargy]] and [[confusion]]. [[Endotracheal intubation]] is performed in impending [[respiratory failure]] to maintain airway, perform frequent [[pulmonary toilet]] and manage acute [[respiratory failure]]. Operative [[bronchoscopy]] can be performed for direct visualisation of [[trachea]], confirmation of the diagnosis and removal of [[pseudomembranes.]]  [[Endotracheal intubation]] rate has been reported between 38% to 100%  and the mean duration of [[intubation]] is 3.2 days.  It is therefore a crucial part of management of [[tracheitis]] which requires judicious assessment of the [[airway]] patency and the urgent availability of skills and expertise required for immediate [[airway intubation]]. Empiric broad spectrum [[Antibiotic|antibiotics]] are initially used to control the [[Infection|infection.]] As the [[Trachea|tracheal]] [[Culture medium|culture]] result becomes available the [[Antibiotic|antibiotics]] can be changed according to the [[organism]] isolated. Most commonly isolated [[Organism|organisms]] include [[Staphylococcus aureus|Staphylococcus Aureus]], [[Streptococcus Penumoniae Infection|Streptococcus Pneumonia]] and [[Moraxella catarrhalis|Moraxella Catarrhalis]]. [[Cephalosporins|Third generation cephalosporin]] combined with an anti staphylococcal [[antibiotic]] e.g [[Nafcillin]], [[Vancomycin]] , [[Clindamycin]] are included in the initial [[antibiotic]] regimen. Current guidelines have outlined a total treatment duration of 10 to 14 days.
Supportive respiratory care is provided in less severe clinical presentation. This includes supplemental [[oxygen]] ( Sp02=94%)and [[bronchodilators]] ([[Epinephrine (patient information)|Epinephrine]] or [[Albuterol]]). [[Anti-pyretics]] can be used for [[Fever|fever.]] [[Corticosteroids]] have not proven benefit but are still used nonetheless.


==References==
==References==

Latest revision as of 04:33, 1 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Dushka Riaz, MD

Overview

Tracheitis is the bacterial infection of the trachea. It is also known as bacterial croup or acute laryngotracheobronchitis. It results in airway inflammation with mucosal edema, tracheal ulceration and thick membranous exudates. It is most commonly caused by a superimposed bacterial infection following a viral upper respiratory tract infection. Common bacterial pathogens include Staphylococcus Aureus, Haemophilus Influenza, Streptococcus Viridans and Moraxella Catarrhalis. It is a disease most commonly encountered in the pediatric age group, between 2-10 years of age. However, mechanical ventilation can also cause tracheitis as it allows colonization of the trachea through endotracheal tube. Clinical features include cough, hoarseness, stridor which can rapidly progress into respiratory distress within 36 to 72 hours. Acute airway obstruction can also develop due to rapid formation of tracheal exudates. Securing airway by endotracheal intubation is therefore crucial in management of tracheitis along with early initiation of empiric antibiotics. Rigid endoscopy is performed to remove thick membranous exudates, known to cause significant tracheal lumen obstruction. Complications of tracheitis include airway obstruction, acute respiratory distress syndrome, toxic shock syndrome, septic shock and multi organ failure. [1] [2] [3] [4] [5]

References

  1. ↑ "StatPearls". 2021. PMID 29262085.
  2. ↑ Blot M, Bonniaud-Blot P, Favrolt N, Bonniaud P, Chavanet P, Piroth L (2017). "Update on childhood and adult infectious tracheitis". Med Mal Infect. 47 (7): 443–452. doi:10.1016/j.medmal.2017.06.006. PMC 7125831 Check |pmc= value (help). PMID 28757125.
  3. ↑ Jones R, Santos JI, Overall JC (1979). "Bacterial tracheitis". JAMA. 242 (8): 721–6. PMID 379379.
  4. ↑ Hopkins A, Lahiri T, Salerno R, Heath B (2006). "Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis". Pediatrics. 118 (4): 1418–21. doi:10.1542/peds.2006-0692. PMID 17015531.
  5. ↑ Gallagher PG, Myer CM (1991). "An approach to the diagnosis and treatment of membranous laryngotracheobronchitis in infants and children". Pediatr Emerg Care. 7 (6): 337–42. doi:10.1097/00006565-199112000-00004. PMID 1788120.

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