What is Tracheitis?
Tracheitis is an inflammation of the trachea that can be caused by viral or bacterial infection, presenting with cough, stridor, wheezing, and respiratory distress, and represents a secondary bacterial infection following a primary viral respiratory illness in most cases. 1, 2, 3
Clinical Definition and Pathophysiology
Tracheitis involves inflammation of the tracheal mucosa, often with formation of mucopurulent exudates or pseudomembranes that can cause acute upper airway obstruction 2, 3
The condition typically develops as a secondary bacterial superinfection following a primary viral respiratory infection, most commonly parainfluenza virus 3
Viral infection causes tracheal mucosal injury and impairs normal phagocytic function, creating conditions favorable for bacterial invasion 3
The most common bacterial pathogens are Staphylococcus aureus and Haemophilus influenzae, though Streptococcus pyogenes and Moraxella catarrhalis are also implicated 3, 4, 5
Clinical Presentation
Key symptoms include fever, cough, dyspnea, and stridor or wheezing caused by airway constriction 6
Patients present with a prodromal upper respiratory illness followed by progressive stridor and variable degrees of respiratory distress 3
Recent epidemiologic shifts show stridor and respiratory distress are now the predominant presenting features 4
Unlike viral croup, patients with bacterial tracheitis do not respond to aerosolized racemic epinephrine or corticosteroids 3, 4
Wheezing occurs due to airway narrowing and turbulent airflow through the inflamed trachea 6
Critical Diagnostic Pitfalls
Differentiating between tracheitis and acute bronchitis based on symptoms alone is often impossible in clinical practice, and these entities are frequently grouped together as acute tracheobronchitis 7
Tracheitis is frequently misdiagnosed as asthma when wheezing is present, particularly when patients have chronic cough unresponsive to typical asthma treatments 6
Poor response to typical asthma treatments or croup therapies should raise suspicion for bacterial tracheitis 6, 4
The only definitive diagnostic method is direct visualization of the trachea via bronchoscopy, though this may not be required in all cases 2
Clinical Severity and Complications
Bacterial tracheitis can cause life-threatening airway obstruction and represents a medical emergency 2, 4
If untreated, airway obstruction can progress to respiratory failure due to extensive pseudomembrane formation 6
Most patients with bacterial tracheitis require endotracheal intubation, with younger children more likely to require this intervention 3, 5
Reported complications include pneumonia, pneumothorax, toxic shock syndrome, and cardiopulmonary arrest 3
Clinical Spectrum
A less severe subset exists, termed "exudative tracheitis," characterized by tracheal membranes but less systemic toxicity 5
In this milder form, 60% of patients may be afebrile at presentation, and only 53% require intubation 5
Older patients who are less systemically ill and rapidly respond to therapy are more characteristic of this exudative variant 5
Nosocomial and Special Populations
Ventilator-associated tracheitis has emerged as an important entity in intensive care settings 1
Fungal tracheitis is increasingly recognized in immunocompromised patients 1
Purulent tracheobronchitis may mimic clinical signs of hospital-acquired pneumonia in intubated patients and may require antibiotic therapy 7
Tracheal colonization is common in intubated patients but does not require therapy in the absence of clinical infection 7