Bacterial Tracheitis

What bacterial tracheitis is

The trachea is the tube that carries air from the voice box (larynx) to the lungs. In bacterial tracheitis, bacteria infect the lining of the trachea just below the voice box, usually after a virus has damaged it. The infection causes swelling, thick pus and sticky membranes that can slough off and block the narrow airway of a child.

It is rare, but it is now one of the more common causes of life-threatening upper airway infection in children, since vaccination has made epiglottitis uncommon.

Causes

The usual sequence is a viral infection, such as parainfluenza (croup) or influenza, followed by a bacterial "superinfection." Common bacteria:

• Staphylococcus aureus, including MRSA (most common)
• Streptococcus pneumoniae and group A Streptococcus
• Moraxella catarrhalis
• Haemophilus influenzae

Risk factors include recent viral illness, influenza, and in adults, weakened immunity or a recent breathing tube.

Symptoms

Bacterial tracheitis often begins like croup:

• barking cough and hoarse voice
• mild fever and runny nose for 1 to 3 days

Then it worsens over hours:

• high fever, often above 39 °C (102.2 °F)
• toxic appearance: the child looks very unwell, pale and lethargic
• stridor (harsh noise on breathing in), sometimes also on breathing out
• cough with thick, purulent secretions
• difficulty breathing, with chest retractions
• no improvement with the steroids and nebulized epinephrine that help croup

Unlike epiglottitis, children with tracheitis can usually lie flat and do not typically drool.

Bacterial tracheitis vs croup vs epiglottitis

Diagnosis

Diagnosis is mainly clinical, made in the emergency department. Tests include:

• neck X-ray, which may show a narrowed or irregular trachea with membranes
• direct look with a scope (laryngoscopy or bronchoscopy) in a controlled setting such as the operating room, which confirms thick secretions and membranes
• cultures of the tracheal secretions to identify the bacteria
• blood tests, including white cell count and blood cultures

Doctors avoid upsetting the child, because crying can worsen airway obstruction.

Treatment

• Airway support: many children need a breathing tube (intubation) and admission to the pediatric intensive care unit, often for several days.
• Bronchoscopy to suction thick secretions and remove membranes.
• IV antibiotics covering Staph aureus (including MRSA where common) and other likely bacteria, then narrowed according to culture results. Courses are typically 10 to 14 days.
• Oxygen, fluids and fever control.

Complications

• airway obstruction and respiratory arrest
• pneumonia
• toxic shock syndrome
• sepsis
• narrowing of the trachea later (rare)

Outlook

With rapid recognition and intensive care, most children recover fully. Delayed treatment risks sudden airway blockage, which is why a croup-like illness that worsens with high fever needs emergency assessment.

Prevention

• Annual flu vaccination for children 6 months and older reduces a key trigger.
• Routine childhood vaccines, including Hib and pneumococcal vaccines.
• Handwashing to reduce viral infections.

Frequently asked questions

What is the difference between croup and bacterial tracheitis?

Croup is a viral infection that causes a barking cough and stridor, usually with mild fever, and responds well to steroids. Bacterial tracheitis often starts like croup but becomes much more severe, with high fever, thick secretions, a very ill appearance and poor response to croup treatment.

Is bacterial tracheitis contagious?

The bacteria themselves are common and carried by many people. The viral infections that often precede tracheitis, such as flu and parainfluenza, are contagious. Tracheitis itself does not usually spread as tracheitis from child to child.

How long does bacterial tracheitis last?

Most children need several days in the hospital, often in intensive care, and IV antibiotics. Total antibiotic treatment usually lasts 10 to 14 days. Most recover fully within a few weeks.

Can adults get bacterial tracheitis?

Yes, but it is much less common. In adults it tends to occur after flu, in people with weakened immunity, or after a breathing tube. Symptoms include fever, sore throat, cough and breathing difficulty.