Tracheitis

Description

Infection of the trachea associated with airway inflammation and obstruction:

  • Acute tracheitis: Sudden onset; higher morbidity and mortality
  • Subacute tracheitis: Indolent presentation and course; more common among children with prolonged intubation, tracheostomy, and/or underlying respiratory or neurologic conditions

General Prevention

  • Routine childhood immunization with Haemophilus influenzae type B and pneumococcal vaccines
  • Influenza vaccination in children identified and targeted by the American Academy of Pediatrics
  • Avoid overaggressive suctioning of children with artificial airways.

Epidemiology

  • Viral prodrome common
  • Increased incidence during viral respiratory season (fall and winter): Up to 75% coinfected with influenza A
  • Gender predisposition unclear (2:1 male-to-female ratio has been reported)

Pathophysiology

  • Epithelial damage from a viral infection or mechanical trauma (endotracheal intubation, surgical procedure) occurs in the trachea at the level of the cricoid cartilage. As a result, the damaged tissue is more susceptible to bacterial superinfection.
  • Mucosal damage characterized by marked subglottic edema, copious purulent secretions, and a pseudomembrane (mucosal lining, inflammatory products, and bacteria). These changes lead to marked airway obstruction.
  • Toxic shock syndrome may be a consequence if the infection is associated with toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes.

Etiology

  • Bacteria:
    • Staphylococcus aureus (most common), group A β-hemolytic streptococcus, Moraxella catarrhalis, and nontypeable H. influenzae
    • Pseudomonas aeruginosa, other Gram-negative enteric bacteria have been associated with nosocomial infections.
    • Mycobacterium tuberculosis, Mycoplasma pneumoniae, Corynebacterium diphtheria, H. influenzae type B, and respiratory anaerobic bacteria are uncommon pathogens.
  • Viruses: Influenza, parainfluenza, respiratory syncytial, herpes simplex, and measles viruses have been found with bacterial pathogen(s).
  • Fungi: Seen with underlying immunodeficiency disorders or chronic steroid use