Definition

Bacterial tracheitis, also known as bacterial croup or acute laryngotracheobronchitis, is an infection of the trachea caused by bacteria. The trachea, or windpipe, is the tube that connects the nose to the lower respiratory tract and lungs. When you inhale air through your nose or mouth, the air flows through the throat and then down the trachea. The trachea then branches into two tubes called the right bronchus and the left bronchus. These bronchi further divide and end in the lungs.

Besides serving as a pathway for oxygen during inhalation, the trachea is also an exit route for carbon dioxide, a byproduct of the body’s energy production, during exhalation. Bacterial tracheitis is a rare but potentially life-threatening condition that primarily affects young children. Prompt and proper treatment is crucial to save a child’s life.

Causes

Bacterial tracheitis is most commonly caused by the bacteria Staphylococcus aureus. Other bacteria that can cause this infection include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

Most cases of bacterial tracheitis develop after a cold or the common flu. After a child suffers from an upper respiratory tract infection, such as the flu, measles, or parainfluenza, bacteria can more easily infect the child’s trachea, leading to tracheitis. This occurs because the virus damages the tracheal lining, making it more susceptible to infection. This condition results in rapid infection, inflammation, and swelling of the trachea. Given the small size and position of a child’s trachea, even slight swelling can quickly obstruct their airway.

Although bacterial tracheitis can also affect adults, it progresses more slowly in them. In adults, the infection can often resolve on its own before the airway becomes obstructed.

Risk Factor

Risk factors for bacterial tracheitis include:

• Long-term use of a tracheostomy. Tracheostomy is a procedure to aid breathing by inserting a tube into the front of the neck. Long-term use can lead to bacterial growth on the tracheostomy tube
• Being a school-age child
• History of upper respiratory viral infections, most commonly caused by the influenza and parainfluenza viruses
• Weakened immune systems, especially in children who have undergone long-term tracheostomy
• Increased cases of flu in the fall and winter seasons

It is important to note that having risk factors does not mean a person will definitely develop the condition. Risk factors increase the likelihood of developing a condition compared to individuals without risk factors. Conversely, not having risk factors does not mean that someone will not develop this condition.

Symptoms

If a child develops bacterial tracheitis, it is likely to occur after they have had an upper respiratory infection (URI), such as the common cold. Initially, symptoms of bacterial tracheitis resemble those of other upper respiratory infections in the first 1-3 days and may worsen in the following days.

Early symptoms include coughing, runny nose, and a mild fever. After two to five days, symptoms can progress to include signs of infection and airway obstruction. Signs and symptoms of tracheitis include:

• High fever
• Severe cough
• Difficulty breathing
• Additional breathing sounds, such as wheezing (a high-pitched whistling sound)
• Nasal flaring during breathing, indicating breathing difficulty
• Cyanosis (a bluish discoloration of the skin)
• Stridor, a high-pitched wheezing sound heard during breathing, indicates serious infection and partial airway obstruction, which can be life-threatening

Diagnosis

Doctors diagnose bacterial tracheitis based on the patient's symptoms, comprehensive medical history, and physical examination. The doctor will listen to the breathing sounds using a stethoscope to detect signs of respiratory distress.

To confirm the diagnosis and rule out other possible causes, the doctor may recommend additional tests such as:

• Sputum culture to identify the bacteria causing tracheitis by sampling mucus from the back of the nose or trachea
• Blood gas tests to measure oxygen levels in the patient’s blood
• Chest X-rays to detect inflammation, swelling, or infection in the respiratory tract
• Endoscopy, a procedure to visualize the inside of the throat using a flexible tube with a camera at the end, with images displayed on a monitor

Management

Patients with bacterial tracheitis require hospitalization, usually in the intensive care unit (ICU). Doctors will administer antibiotics to kill the bacteria causing the infection, given through injections. The airway will also be cleaned.

If the patient needs breathing assistance, the doctor will perform intubation, inserting an endotracheal tube through the mouth into the trachea, which is then connected to a ventilator. This procedure helps improve lung function as the patient recovers from the infection.

Prompt treatment significantly affects the patient’s recovery process. After symptoms improve, recovery in children is typically better than in adults. Most children recover without long-term complaints or complications.

Complications

The condition of a child with bacterial tracheitis depends on the severity and how quickly they receive treatment. The airway of a small child can swell quickly, making it difficult to breathe. If the child’s trachea becomes completely obstructed, it can lead to respiratory arrest and death.

If the infection is caused by Staphylococcus aureus, there is also a risk of toxic shock syndrome, characterized by a sudden drop in blood pressure and inadequate oxygen supply to body tissues, leading to fever, shock (low blood pressure and lack of oxygen), organ failure, and potentially death.

Other possible complications include:

• Airway obstruction
• Pneumonia, reported in 19-60% of cases
• Sepsis, where the infection spreads through the bloodstream to the entire body
• Acute respiratory distress syndrome (ARDS)
• Complications from the endotracheal tube, such as blockage of the tube, accidental dislodgment, or narrowing of the throat around the larynx
• Anoxic encephalopathy, or brain damage due to insufficient oxygen supply
• Cardiac arrest and/or respiratory arrest

Prevention

Prevention measures include routine handwashing, maintaining a healthy immune system, and practicing healthy lifestyles.

Other preventive measures for bacterial tracheitis include vaccination against pneumococcal bacteria and viruses (such as measles and influenza) that can be risk factors for bacterial tracheitis and additional bacterial respiratory infections.

For children with a tracheostomy or throat tube, proper care and hygiene of the tracheostomy tube are essential to prevent bacterial infection. Care includes daily cleaning of the inner tube and monthly cleaning of the entire tube.

When to See a Doctor? 

If you or your child experiences symptoms of bacterial tracheitis as mentioned above, seek medical help immediately. Tracheitis is a medical emergency. Visit the emergency room if your child has an upper respiratory infection and suddenly develops a high fever, worsening cough, or difficulty breathing.