Bacterial tracheitis is a serious upper airway infection, primarily affecting children aged 5-7, often following a viral illness. Symptoms include a brassy cough, high fever, and respiratory distress, with diagnosis made through clinical evidence rather than imaging. Treatment focuses on airway management, supportive care, and antibiotics, with a generally excellent prognosis if properly managed.

1. Lecture: Bacterial Tracheitis
Lecturer: Dr Abdirashid Dahir Herow
Paediatric Resident
Class 3.2

2. Bacterial Tracheitis
• Bacterial tracheitis is an acute bacterial
infection of the upper airway that is potentially
life-threatening.
• The mean age is between 5 and 7 yr. There is a
slight male predominance.

3. • Male predominance.
• It is often follows a viral respiratory
infection(Laryngotracheitis)

4. ETIOLOGY
• S. aureus
• S. pneumoniae
• S. pyogenes
• Moraxella catarrhalis
• nontypeable H. influenzae
• Anaerobic organisms

5. Clinical Manifestations
• Typically the child has a brassy cough,
apparently as part of a viral
laryngotracheobronchitis. High fever and
toxicity with respiratory distress can occur
immediately or after a few days of apparent
improvement. The patient can lie flat, does not
drool, and does not have the dysphagia
associated with epiglottitis.

6. • The major pathologic feature appears to be
mucosal swelling at the level of the cricoid
cartilage, complicated by copious, thick,
purulent secretions, sometimes causing
pseudomembranes

7. Diagnosis
• The diagnosis is clinical and based on
evidence of bacterial upper airway disease,
which includes high fever, purulent airway
secretions, and an absence of the classic
findings of epiglottitis. X-rays are not needed
but can show the classic findings purulent
material is noted below the cords during
endotracheal intubation.

8. • Lateral radiograph of the neck of a patient with bacterial tracheitis, showing pseudomembrane detachment in the trachea

9. Complications
• Cardiorespiratory arrest
• Toxic shock syndrome .

10. Treatment
Airway management and treatment of hypoxia.
• Intubation or tracheotomy (tube 0.5-1.0 mm smaller than
estimated by age or height)
Treatment of the respiratory distress
• Nebulized racemic epinephrine (0.25-0.5 mL
of 2.25% racemic epinephrine in 3 mL of normal
saline every 20 min
• Dexamethasone (dose 0.15- 0.6 mg/kg) single
doses I.M or Oral.

11. • Empiric therapy recommendations for
bacterial tracheitis include vancomycin or
clindamycin and a 3rd-generation
cephalosporin (e.g., ceftriaxone or cefepime).

12. Supportive care including
• Humidified air or oxygen
• Antipyretics
• Encouragement of fluid intake

13. Prognosis
The outcome of acute laryngotracheobronchitis,
laryngitis, and spasmodic croup is also excellent.
Most deaths from croup are caused by a laryngeal
obstruction or by the complications of tracheotomy.
The prognosis of tracheitis for most patients is
excellent.
• Patients usually become afebrile within 2-3 days of
the institution of appropriate antimicrobial therapy,
but prolonged hospitalization may be necessary.

14. •END