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Bacterial tracheitis

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Bacterial tracheitis

  1. 1. Bacterial TracheitisProf. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE Saadsalani@yahoo.com
  2. 2. Introduction Bacterial tracheitis is an uncommon infectious cause of acute upper airway obstruction, BUT it is more prevalent than acute epiglottitis Huang YL, Peng CC, Chiu NC, et al. Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 2009 Feb. 51(1):110-3 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 2
  3. 3. Introduction (Cont.) Patients may present with croup-like symptoms, such as barking cough, stridor, and fever Holmes A. Croup: What It Is and How to Treat It. US Pharm. 2013. 38(7):47-50. 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 3
  4. 4. Pathophysiology Bacterial tracheitis Is a diffuse inflammatory process of the larynx, trachea, and bronchi with adherent or semi-adherent mucopurulent membranes within the trachea. Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct. 27(10):950-3 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 4
  5. 5. Pathophysiology (Cont.) Acute airway obstruction may develop secondary to: • Subglottic edema and sloughing of epithelial lining or • Accumulation of mucopurulent membrane within the trachea Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct. 27(10):950-3 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 5
  6. 6. Pathogenesis • The pathogenesis?? • The factors that predispose the airway to invasive infection with common pyogenic organisms, include preceded:  Viral infection  Injury to the trachea from recent intubation  Trauma Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 6
  7. 7. Epidemiology Bacterial tracheitis Remains a rare condition, with an estimated incidence of approximately 0.1 cases per 100,000 children per year Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. 2009 Apr 28. 1-10. 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 7
  8. 8. Clinical Presentation • The age: range was from 3 weeks to 16 years, with a mean age of 4 years • The prodrome is usually an upper respiratory infection, followed by progression to: - Higher fever - Cough - Inspiratory stridor - Variable degree of respiratory distress Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 8
  9. 9. Clinical Presentation (cont.) • The classic presentation : -Fevers -Toxic appearance -Stridor -Tachypnea -Respiratory distress -Cough is frequent and not painful. Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 9
  10. 10. Clinical Presentation (cont.) • A high index of suspicion for bacterial tracheitis is needed in children with viral croup–like symptoms who do not respond to standard croup treatment or clinically worsen. Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 10
  11. 11. Clinical Presentation (cont.) Clinical examination: • Inspiratory stridor (with or without expiratory stridor) • Bark- like or brassy cough • Hoarseness • Worsening or abruptly occurring stridor Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 11
  12. 12. Clinical Presentation (cont.) • Varying degrees of respiratory distress:  Retractions  Dyspnea  Nasal flaring  Cyanosis • Sore throat, odynophagia • Dysphonia Salamone FN, Bobbitt DB, Myer CM, Rutter MJ, Greinwald JH Jr. Bacterial tracheitis reexamined: is there a less severe manifestation?. Otolaryngol Head Neck Surg. 2004 Dec. 131(6):871-6 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 12
  13. 13. Causative factors • S aureus • S pyogenes, Streptococcus pneumoniae • Moraxella catarrhalis • Haemophilus influenzae type B (less common) • Klebsiella species • Pseudomonas species • Anaerobes 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 13
  14. 14. Causative factors(Cont.) • Peptostreptococcus species • Bacteroides species • Mycoplasma pneumoniae • Mycobacterium tuberculosis (endobronchial disease) • H1N1 influenza 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 14
  15. 15. Differential diagnosis • Croup • Angioedema • Epiglottitis • Peritonsillar abscess • Retropharyngeal Abscess 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 15
  16. 16. Laboratory Investigations In patients with suspected bacterial tracheitis: • bacterial culture and Gram stain of tracheal secretions • blood cultures 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 16
  17. 17. Radiography Radiology neither definitive nor essential May reveal : • Subglottic narrowing on anteroposterior (AP) views - Steeple sign, similar to croup • Clouding of tracheal air column or irregular tracheal margin on lateral view • Foreign body-like due to Concretions of epithelium and inflammatory cells 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 17
  18. 18. Steeple sign https://radiopaedia.org/articles/steeple-sign-trachea 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 18
  19. 19. Bacterial tracheitis : Lateral neck X-ray https://avoidingerrors.com/2016/05/07/airway/ 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 19 lateral neck X-ray shows intraluminal narrowing or irregulaties on trachea
  20. 20. Retropharyngeal abscess : Lateral neck X-ray EB Medicine/ 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 20
  21. 21. Laryngotracheobronchoscopy Indications • Only definitive means of diagnosis • May be therapeutic by performing tracheal toilet and stripping purulent membranes • Direct visualization and culture of purulent tracheal secretions 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 21
  22. 22. Management • Maintenance of an adequate airway is of primary importance • Avoid agitating the child • Most patients (57-100%) require eventual intubation. 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 22 Gross JH, Giraldez-Rodriguez LA, Klein AM. Bacterial Laryngotracheitis and Associated Upper Airway Obstruction: A Case Series. Ann Otol Rhinol Laryngol. 2015 Dec. 124 (12):1002-5
  23. 23. Management(Cont..) • Third-generation cephalosporin (e.g., cefotaxime, ceftriaxone) and a penicillinase- resistant penicillin (e.g., oxacillin, nafcillin). • Vancomycin (45 mg/kg/d IV, divided every 8 h), with or without clindamycin, should be started:  In patients who : o appear toxic o have multiorgan involvement  if MRSA is prevalent in the community. 08/10/2017Bacterial Tracheitis Prof.Dr. Saad S Al Ani 23 Gross JH, Giraldez-Rodriguez LA, Klein AM. Bacterial Laryngotracheitis and Associated Upper Airway Obstruction: A Case Series. Ann Otol Rhinol Laryngol. 2015 Dec. 124 (12):1002-5
  24. 24. Tracheostomy • Is rarely necessary unless injury or trauma to the airway has caused scarring and documented narrowing of the airway. 08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani 24
  25. 25. Complications • Pneumonia • Septicemia • Toxic shock syndrome • Anoxic encephalopathy • Cardiorespiratory arrest • Endotracheal tube complications 08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani 25
  26. 26. Prognosis Complete recovery is expected once the patient is past the acute phase, 08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani 26
  27. 27. References • Miranda AD, Valdez TA, Pereira KD. Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011 Oct. 27(10):950-3. • Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician. 2011 May 1. 83(9):1067-73. • Tebruegge M, Pantazidou A, Thorburn K, et al. Bacterial tracheitis: a multi-centre perspective. Scand J Infect Dis. 2009 Apr 28. 1-10 08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani 27
  28. 28. Thank you 08/10/2017Bacterial Tracheitis Prof. Dr. Saad S Al Ani 28

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