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Which of the following is/are true of bacterial tracheitis?
- Children presenting with bacterial tracheitis tend to be older than children presenting with viral croup
- Children with bacterial tracheitis do not respond as well to racemic epinephrine and steroids as children with viral croup
- Children with bacterial tracheitis may have a “steeple sign” on xray
- Children with bacterial tracheitis most commonly have Strep pneumoniae infection
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October 17, 2019 at 10:52 pm
C) 1, 2, and 3 are true
Bacterial tracheitis is a rare but serious infection often resulting as a bacterial superinfection following a viral respiratory prodrome. The peak age is 3-8 years, older than children with viral croup. Patients are often toxic appearing, and may present with fever, stridor, cough, and respiratory distress. Drooling and tripod positioning are less common (these are more indicative of epiglottitis). A clue to differentiate bacterial tracheitis from viral croup is lack of response or partial response to racemic epinephrine and steroids. Xrays may show a steeple sign similar to croup, and may show a shaggy appearance to the tracheal column on lateral (“dripping candle sign”). CXR show signs of pneumonia in up to 50%. Diagnosis is by bronchoscopy, preferably performed by ENT in the O.R. Broad spectrum antibiotics, covering MRSA and MSSA as Staph aureus is the most common organism found, should be started if bacterial tracheitis is suspected, even before the diagnosis is confirmed. If emergent intubation is required, ETT 1-2 sizes smaller should be readily available.