This acute bacterial infection of the trachea often also involves the larynx and bronchi. It has been called bacterial laryngotracheobronchitis and pseudomembranous croup.
A cause of acute airway obstruction, this condition may potentially be life threatening.
Most patients are <3 years of age (usually 3 months to 2 years), although older children may be affected. There are no clear sex differences in incidence or severity.
There seems to be no seasonal preferences.
Etiology and Pathophysiology
The most common cause is Staphylococcus aureus, but other encountered agents are H. influenzae, S. pneumoniae, and Moraxella catarrhalis. Anaerobic organisms have also been reported.
Invasion of opportunistic bacterial organisms, often following an upper airway viral infection, causes subglottic edema with ulcerations, copious and purulent secretions, and pseudomembrane formation.
Clinical Presentation
The typical presentation involves a history of an upper respiratory infection (URI) for approximately 3 days characterized by a low-grade fever and a “brassy” cough. The illness then evolves rapidly with high fever and onset of stridor, resulting in progressive deterioration and development of acute respiratory distress.
Patients generally appear toxic.
There is also evidence of purulent airway secretions.
The typical presentation involves a history of an upper respiratory infection (URI) for approximately 3 days characterized by a low-grade fever and a “brassy” cough. The illness then evolves rapidly with high fever and onset of stridor, resulting in progressive deterioration and development of acute respiratory distress.
Patients generally appear toxic.
There is also evidence of purulent airway secretions.
Diagnosis
Diagnosis is clinical with classical signs of epiglottitis and croup absent. Direct visualization of the trachea via laryngoscopy demonstrates thick, abundant, and purulent secretions.
The differential diagnosis includes epiglottitis (although no dysphagia or drooling, and patient may lie flat), croup (although voice is normal and there is a lack of a barky cough), and laryngeal and retropharyngeal abscess.
Diagnosis is clinical with classical signs of epiglottitis and croup absent. Direct visualization of the trachea via laryngoscopy demonstrates thick, abundant, and purulent secretions.
The differential diagnosis includes epiglottitis (although no dysphagia or drooling, and patient may lie flat), croup (although voice is normal and there is a lack of a barky cough), and laryngeal and retropharyngeal abscess.
Treatment
Management of the airway is critical with intubation, and assisted ventilation should be strongly considered.
There is no proven role for bronchodilators or corticosteroids.
Antimicrobial therapy should be immediately instituted. Choice of therapy includes broad-spectrum antibiotics with antistaphylococcal activity.
Management of the airway is critical with intubation, and assisted ventilation should be strongly considered.
There is no proven role for bronchodilators or corticosteroids.
Antimicrobial therapy should be immediately instituted. Choice of therapy includes broad-spectrum antibiotics with antistaphylococcal activity.
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