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Otolaryngology--head and Neck Surgery :... Mar 2019To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key... (Review)
Review
OBJECTIVE
To review the presentation and treatment of children diagnosed with bacterial tracheitis at our institution and to review the available literature focusing on key presenting symptoms and clinical outcomes of children diagnosed with bacterial tracheitis.
STUDY DESIGN
Case series with literature review.
SETTING
Tertiary children's hospital and available literature.
SUBJECTS AND METHODS
Case series of children with bacterial tracheitis retrospectively reviewed at a tertiary children's hospital. Those with a tracheostomy or those who developed bacterial tracheitis as a complication of prolonged intubation were excluded.
RESULTS
Thirty-six children were identified (mean ± SD age, 6.7 ± 4.5 years). The most common presenting symptom was cough (85%), followed by stridor (77%) and voice changes/hoarseness (67%). A concurrent viral illness was found for 55%, and the most common bacteria cultured was methicillin-sensitive Staphylococcus aureus. Pediatric intensive care admission occurred for 69%, and 43% required intubation. No patient required tracheostomy. One patient (2.7%) died secondary to airway obstruction and subsequent respiratory arrest. Four patients had recurrence of bacterial tracheitis 4 to 12 months following their initial presentation.
CONCLUSION
Bacterial tracheitis is an uncommon condition with an atypical presentation and variable clinical course but serious consequences if left unrecognized. Staphylococcus is the most common bacteria identified, and many patients will have a prodromal viral illness. Changes in patient epidemiology and presentation may have occurred over time.
Topics: Airway Obstruction; Child; Child, Preschool; Cohort Studies; Female; Hospitalization; Humans; Male; Pneumococcal Infections; Staphylococcal Infections; Tracheitis
PubMed: 30348058
DOI: 10.1177/0194599818808774 -
The Journal of Laryngology and Otology Nov 1989Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the... (Review)
Review
Bacterial tracheitis is the term used to describe a severe infraglottic infection characterized by toxicity, brassy cough, inspiratory stridor, subglottic oedema and the presence of copious mucopurulent secretions in the trachea. It is an uncommon condition that requires prompt diagnosis and intensive medical therapy if significant morbidity and mortality are to be avoided. Since the condition was first described in 1979 approximately one hundred cases have been reported. In this paper we present four children with bacterial tracheitis to add to the current literature. Interestingly, one child was admitted on two separate occasions with the disease, an event not previously recorded. All patients underwent endoscopy which revealed findings typical of bacterial tracheitis in each case. None required tracheostomy though three required nasotracheal intubation. Post-endoscopy all were managed in the Intensive Care Unit. There were no fatalities or significant morbidity. The average duration of hospitalization was seven days.
Topics: Bacterial Infections; Child; Child, Preschool; Female; Humans; Length of Stay; Male; Recurrence; Tracheitis
PubMed: 2691598
DOI: 10.1017/s0022215100110989 -
Pediatrics in Review Nov 2014
Topics: Anti-Bacterial Agents; Child; Cold Temperature; Cough; Diagnosis, Differential; Fever; Humans; Laryngoscopy; Pharyngitis; Radiography; Seasons; Trachea; Tracheitis
PubMed: 25361911
DOI: 10.1542/pir.35-11-497 -
Scandinavian Journal of Infectious... 2009The published literature on bacterial tracheitis is limited. We report the first multi-centre study of bacterial tracheitis together with a concise review of the... (Review)
Review
The published literature on bacterial tracheitis is limited. We report the first multi-centre study of bacterial tracheitis together with a concise review of the literature. We conducted a retrospective study of cases admitted during the period 1993-2007 to 3 tertiary paediatric centres in the United Kingdom and 1 in Australia. A total of 34 cases were identified. 31 patients (91%) required intubation. Complications included cardiorespiratory arrest in 1, ARDS in 1, hypotension in 10, toxic shock syndrome in 1 and renal failure in 1 patient(s). Staphylococcus aureus was the most commonly implicated bacterial organism, isolated from the respiratory tract in 55.8% of the cases overall. Other pathogens commonly isolated from the respiratory tract included Streptococcus pyogenes (5.9%), Streptococcus pneumoniae (11.8%) and Haemophilus influenzae (11.8%). Viral coinfection was identified in 9 (31%) of the 29 cases in whom immunofluorescence testing was performed (influenza A in 4 cases; parainfluenza 1 in 2 cases; parainfluenza 3 in 2 cases; adenovirus in 1 case). The combined experience from 4 major paediatric intensive care units suggests that bacterial tracheitis remains a rare condition with an estimated incidence of approximately 0.1/100,000 children per year. Short-term complications were common but long-term sequelae were rare. There were no fatal outcomes, which contrasts with the high historical mortality rates and likely reflects improvements in intensive care management.
Topics: Adolescent; Australia; Bacteria; Bacterial Infections; Child; Child, Preschool; Comorbidity; Female; Humans; Incidence; Infant; Male; Retrospective Studies; Tracheitis; United Kingdom; Virus Diseases; Viruses
PubMed: 19401934
DOI: 10.1080/00365540902913478 -
CMAJ : Canadian Medical Association... Jan 1989We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol... (Review)
Review
We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol for 13 of the patients included the use of nasotracheal intubation. The infection was caused by Staphylococcus aureus in seven, Haemophilus influenzae in three, Branhamella catarrhalis in one and Streptococcus pneumoniae in one. Both H. influenzae and B. catarrhalis were isolated in another patient, and no organism was found in the remaining patient. In addition to the bacteria, viruses were cultured from the tracheal secretions of two patients. The mean duration of intubation was 7.6 days and of hospital stay 9.2 days. Twelve of the cases occurred during the cold months of the year (October to March). Of the three deaths only one occurred in the pediatric intensive care unit and was due to severe bronchospasm and an air leak that caused bilateral pneumothorax and pneumomediastinum. In one patient subglottic stenosis developed that necessitated tracheostomy. Healing began 5 to 9 days after the onset of symptoms, as demonstrated with the use of repeated fibreoptic bronchoscopy. We found that the airway could be safely managed with the use of a nasotracheal tube. Bronchoscopy helped to confirm the diagnosis, to remove adherent secretions and to monitor the course of the disease. The ventilation tube can be removed after the patient's temperature returns to normal, if there is an air leak around the tube, if the quantity and viscosity of the secretions decrease and if healing is observed at bronchoscopy.
Topics: Airway Obstruction; Bacterial Infections; Bronchoscopy; Child; Child, Preschool; Female; Humans; Infant; Intubation, Intratracheal; Male; Retrospective Studies; Seasons; Tracheitis
PubMed: 2642395
DOI: No ID Found -
The American Journal of Emergency... May 1991Bacterial tracheitis is an uncommon cause of acute respiratory distress in children. The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an... (Review)
Review
Bacterial tracheitis is an uncommon cause of acute respiratory distress in children. The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an unusual pathogen, Streptococcus pneumoniae. Her clinical presentation and radiographic findings are typical for an older child. Management of this case involved endotracheal intubation, although a review of the literature suggests that airway management can vary with age and size of the tracheal lumen. The microbiology of bacterial tracheitis shows a predominance of Staphylococcus and Streptococcus reported previously, with only three prior reported cases of Pneumococcus.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Pneumococcal Infections; Radiography; Respiratory Insufficiency; Tracheitis
PubMed: 2018595
DOI: 10.1016/0735-6757(91)90087-z -
Pediatrics in Review Sep 2020
Topics: Bacterial Infections; Humans; Tracheitis
PubMed: 32873566
DOI: 10.1542/pir.2019-0181 -
American Family Physician May 2018Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute...
Croup is a common respiratory illness affecting 3% of children six months to three years of age. It accounts for 7% of hospitalizations annually for fever and/or acute respiratory illness in children younger than five years. Croup is a manifestation of upper airway obstruction resulting from swelling of the larynx, trachea, and bronchi, leading to inspiratory stridor and a barking cough. Many patients experience low-grade fevers, but fever is not necessary for diagnosis. Less commonly, stridor can be associated with acute epiglottitis, bacterial tracheitis, and foreign body airway obstruction. Laboratory studies are seldom needed for diagnosis of croup. Viral cultures and rapid antigen testing have minimal impact on management and are not routinely recommended. Radiography and laryngoscopy should be reserved for patients in whom alternative diagnoses are suspected. Randomized controlled trials have demonstrated that a single dose of oral, intramuscular, or intravenous dexamethasone improves symptoms and reduces return visits and length of hospitalization in children with croup of any severity. In patients with moderate to severe croup, the addition of nebulized epinephrine improves symptoms and reduces length of hospitalization.
Topics: Acetaminophen; Airway Management; Airway Obstruction; Antipyretics; Child, Preschool; Croup; Dexamethasone; Glucocorticoids; Humans; Ibuprofen; Infant; Severity of Illness Index; Symptom Assessment; Treatment Outcome
PubMed: 29763253
DOI: No ID Found -
BMJ Clinical Evidence Sep 2014Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway... (Review)
Review
INTRODUCTION
Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with mild croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 19 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline (racemate and L-adrenaline [ephinephrine]).
Topics: Adrenal Cortex Hormones; Budesonide; Cough; Croup; Epinephrine; Helium; Humans; Humidity; Oxygen; Prednisolone
PubMed: 25263284
DOI: No ID Found