Tracheitis Symptoms, Diagnosis, and Treatment

Tracheitis is an infection of the trachea (breathing tube or windpipe) that is caused by bacteria or viruses. The most common bacteria involved include Staphylococcus aeureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa.

Tracheitis most frequently occurs in small children and can make it very difficult to breathe. The condition may also be known as tracheobronchitis, bacterial croup, or laryngotracheobronchitis.

Causes of Tracheitis

Predisposing factors include:

• Prior viral infection that affects the upper airways
• Most commonly occurs between the ages of 3 to 8 years

Tracheitis is rare, only occurring in about one in one million cases. It is suspected to be more prevalent in boys than girls. Because it is so rare, when this disease is present, it is commonly mistaken for viral croup, which is much more prevalent in the community.

Tracheitis is much more serious than croup, and when severe, tracheitis commonly requires your child to receive breathing support.

Symptoms of Tracheitis

Symptoms of tracheitis vary from person to person, but they can include:

• Cough that sounds “croupy,” and the child may cough up secretions
• Breathing difficulties
• Stridor when breathing in (common)
• Wheezing when breathing out (uncommon)
• High fever, usually greater than 102 F or 39 C
• Blue lips (a sign of cyanosis or low oxygen levels), if the ability to breathe is deteriorating

A “croupy cough” is a hallmark symptom of viral croup. It is often described as “barking,” “brassy,” or resembling a seal’s bark. This can also be present in tracheitis, which is why it is commonly confused with the more common illness of viral croup.

Differences Between Tracheitis and Croup

While the cough may sound very similar between tracheitis and viral croup, several features can be used to help distinguish between the two disorders.

Often, viral croup will have a progressively worsening onset, while tracheitis symptoms occur quickly. The fever can sometimes be different, with viral croup being associated with a lower fever than tracheitis, rarely being higher than 102 F. The high fever is usually what drives people to the emergency department.

The standard treatment for viral croup, humidified oxygen and inhaled racemic epinephrine, can also be used to differentiate tracheitis. True tracheitis may not respond to these therapies as often and as quickly as croup. If you notice that your child is getting worse while receiving these treatments, you should alert the nurse or healthcare provider.

Diagnosis

A tracheitis diagnosis can be based on symptoms, as well as patient history and examination. Diagnostic tests that may be performed by your healthcare provider include:

• The measurement of oxygen levels in the blood (pulse oximetry)
• A culture of sputum from the trachea collected during a laryngoscopy which can then be analyzed in the lab to determine the infectious agent causing your symptoms
• An X-ray of the lungs and breathing passageways

During these procedures, your healthcare provider will be using the findings to help differentiate from epiglottitis, another relatively rare disorder that may require rescue interventions for breathing.

Treatment for Tracheitis

Aggressive treatment early on is important in properly managing tracheitis. During a laryngoscopy, your healthcare provider will clear as much of the airway as possible, as there will likely be secretions and membranes that can cause airway obstruction.

Initial treatments will usually require admission into an intensive care unit, where your child can be observed and intubated (breathing tube placed) if necessary. Having a breathing tube will also allow the ICU nurses to perform aggressive airway suctioning to keep your child breathing as comfortably as possible.

Antibiotic treatment for bacterial infection is also necessary. Commonly the antibiotics of choice include IV ceftriaxone and IV vancomycin. If cultures come back resistant to these antibiotics, your child’s regimen will be changed.

IV antibiotics will continue for five to six days, at which point your child can usually be switched to oral antibiotics. The total course of antibiotics will range between one to two weeks.