Bacterial tracheitis is a severe, potentially life-threatening infection of the lower parts of the larynx and trachea, caused by a secondary bacterial infection after an acute respiratory viral infection. Frequency – About 2% of babies hospitalized for croup. The predominant age is from 3 weeks to 13 years. The predominant gender is male (2:1).
- H. influenzae
- Moraxella catarrhalis
- Group A Streptococcus
- Neisseria. Risk factor – SARS.
Pathomorphology. Intense inflammation, desquamation of the subpharyngeal epithelium and abundant purulent-mucous secretion that disrupts the functions of the respiratory tract and makes it difficult to carry out therapeutic measures to restore these functions.
- Barking rough cough
- Voice changes are traditionally absent
- Increase in body temperature >38 °C
- Intoxication syndrome
- Edema of the lower parts of the larynx
- Rapidly developing stridor
traditionally occupies a supine position
- Absence of salivation and dysphagia (important for differential diagnosis with inflammation of the upper larynx)
- No response to aerosol treatment using adrenaline (unlike those with croup).
- Leukocytosis with a shift of the leukocyte formula to the left
- Bacteriological examination of blood is traditionally uninformative
- Bacterioscopy and bacteriological examination of tracheal secretion. Special Studies
- X-ray studies
- X-ray of the neck in a lateral projection – narrowing in the lower parts of the larynx and trachea with blurred X-ray formations (strings)
- Infiltrates can be found in the lungs
- Endoscopic examination: pronounced inflammation of the lower parts of the larynx and trachea with abundant purulent-mucous secretion and desquamated epithelium, separated from the walls of the trachea by layers. Differential Diagnosis
- foreign body
- Retropharyngeal abscess
- false croup
- diphtheria laryngitis.
Tactics of conducting
- Frequent small meals and plenty of fluids. Perhaps the appointment of diet number 13
- Infusion therapy
- Warm humid air in the room
- Endotracheal or nasotracheal intubation (usually for 3-13 days). Drug therapy
- Antibacterial therapy
- Oxacillin sodium salt 0.25-0.5 g 4-6 r / day for adults, 1 g / day for children from 3 months to 2 years in 4-6 doses, 2 g / day for children from 2 to 6 years in 4- 6
- Cefotaxime 1 g intravenously and 12 hours later for adults and children over 12 years old, 50-100 mg/kg/day in 2-4 doses (up to 2 g/day) for children under 12 years of age.
- Cefuroxime 0.75 g 3-4 r / day i.v., 75 mg / kg / day in 4 divided doses for children.
- In case of allergy to penicillins and cephalosporins – clindamycin 40 mg/kg/day in 4 divided doses or chloramphenicol (levomycetin) 75 mg/kg/day in 4 divided doses.
- When coughing, the appointment of expectorants or antitussives is indicated. Joint appointments should be avoided.
- Expectorants – see bacterial pneumonia.
- Antitussives – according to indications (for example, with an unproductive or severe nocturnal cough)
- Glaucine hydrochloride 50 mg 2-3 r / day after meals for adults, 10-30 mg for children. Due to the likely hypotensive effect, the product should not be prescribed for arterial hypotension or myocardial infarction
- Broncholitin 1 tbsp. 3-4 r / day for adults, 1 tsp. 3 r / day for children over 3 years old, 2 tsp. 3 r / day for children over 10 years old
- Libeksin 100 mg 3-4 r / day for adults, 25-50 mg 3-4 r / day for children. To avoid anesthesia of the oral mucosa, the product is recommended to be swallowed without chewing.
- Tusuprex (oxeladine citrate) 10-20 mg 3-4 r / day for adults, 5-10 mg 3-4 r / day for children.
- Post-intubation stenosis of the lower larynx
- Toxic shock syndrome, traditionally due to the production of enterotoxin by staphylococci.
Course and forecast
- Full recovery after correction of airway patency and during intubation up to 13 days
- Lethal outcome – against the background of cardiac and respiratory arrest. See also Bronchiolitis, Diphtheria, Laryngitis ICD
- J04.1 Acute tracheitis
- J04.2 Acute laryngotracheitis