Tracheitis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Tracheitis is a rare, but life-threatening complication usually affecting children in the age range of three to eight years, especially boys. It is the infection of the trachea or windpipe that causes breathing difficulties due to swelling in this region that blocks their small airways. The condition is less likely to occur in adults.

Still, it may affect this age group if a person has a weak immune system, diabetes (high blood sugar), HIV (human immunodeficiency virus), or AIDS (acquired immunodeficiency syndrome), Also, if adults have undergone tracheostomy (a surgical procedure done to create a breathing hole in the windpipe or trachea) and are on mechanical ventilation.

Therefore, tracheitis is a serious medical emergency, and the children suffering from this condition may require intubation (insertion of a breathing tube), IV or intravenous antibiotic therapy, and an intensive care unit (ICU) for proper management of the condition.

What Are the Other Names of Tracheitis?

• Laryngotracheobronchitis or croup (inflammation of the trachea, larynx, or bronchi of the lungs).

• Bacterial croup (a respiratory illness affecting the trachea, larynx, and bronchi)

• Tracheobronchitis (inflammation or swelling of trachea and bronchi)

What Is Laryngotracheobronchitis or Croup?

Laryngotracheobronchitis or croup, looks almost similar to tracheitis, as cough is the common symptom in both conditions. However, certain symptoms distinguish tracheitis from laryngotracheobronchitis or croup. Symptoms include:

• Mild fever.

• Seen in children in the age group of three months to five years.

• Stridor usually occurs with some activity.

• Cough without sputum.

• Worsening symptoms.

• Treatment usually involves inhaled racemic epinephrine and humidified oxygen.

What Are the Causes of Tracheitis?

Tracheitis is a bacterial infection occurring secondary to complications associated with viral infection of the upper respiratory tract. The condition mainly affects young children due to their narrow or small tracheas that often get blocked by the inflammation or swelling caused by this condition.

The causative bacteria of tracheitis include:

• Staphylococcus aureus (41 percent).

• Moraxella catarrhalis (13 percent).

• Streptococcus pneumoniae (15 percent).

• Hemophilus influenzae (18 percent).

• Hemophilus influenzae type B (HiB) (13 percent).

Although the condition is primarily caused by bacterial infection, certain fungal infections, such as zygomycetes and Aspergillus, often lead to tracheostomy-associated tracheitis in adults in the ICU or hospitalized.

What Are the Symptoms of Tracheitis?

Symptoms usually vary from person to person, and they are as follows:

In Children:

• Stridor or high-pitched abnormal respiratory sound while inhaling or breathing in.

• Breathing difficulties.

• Bluish discoloration of lips is due to low oxygen levels or cyanosis. Deteriorating breathing abilities cause the condition.

• Wheezing sound while exhaling or breathing out.

• High-grade fever (above 102 degrees Fahrenheit).

• Croupy cough, along with mucus secretions that get coughed up.

In Adults:

Symptoms in adults are similar to those in children and include:

• Blood in cough.

• Hoarse voice.

• High-grade fever.

• Wheezing.

• Stridor.

• Cough with mucus secretions.

• Breathing difficulties.

• Sore throat.

How Is Tracheitis Diagnosed by the Doctor?

The doctor diagnoses tracheitis depending on the symptoms presented by the patient, clinical or physical examination, and diagnostic testing.

Diagnostic tests include:

• Measurement of blood oxygen levels through pulse oximeter.

• Chest X-rays to view the lungs and airway or breathing passage.

• Nasopharyngeal culture, or sputum, is collected from the trachea during laryngoscopy (an endoscopy of the throat or larynx to view its internal structures) for laboratory investigations to identify the causative agent of tracheitis.

What Are the Treatment Options for Tracheitis?

Timely treatment of tracheitis is beneficial to reduce the risk of complications. The treatment starts by admitting the patient to the intensive care unit (ICU), followed by a deep examination of the airway blockage.

Treatment involves:

• Intubation: Breathing difficulties in a person are overcome by intubating with a thin breathing tube inserted into the trachea through the nose or mouth. The tube helps in aggressive airway suctioning to facilitate easy breathing.

• Antibiotic Therapy: The treatment of tracheitis usually requires intravenous or IV antibiotics for almost six days. Later, oral antibiotics are prescribed for around 14 days.

Antibiotic therapy for tracheitis includes the following medicines:

• Amoxicillin-clavulanic acid.

• Ceftriaxone along with Vancomycin or Nafcillin.

• Ampicillin-sulbactam.

• Clindamycin, along with third-generation Cephalosporins.

• Antifungal Therapy: Fungal infection-induced tracheitis is usually treated with antifungal drugs, such as Voriconazole.

What Are the Complications Associated with Tracheitis?

• Acute respiratory distress syndrome (fluid accumulation in the air sac of the lungs).

• Disseminated intravascular coagulation (abnormal blood clotting).

• Aspiration pneumonia (when water or food gets breathed into the lung’s airway instead of being swallowed).

• Acute ventilatory-dependent respiratory failure (mechanical ventilation-dependent post-respiratory failure).

• Systemic inflammatory response syndrome, septic shock (infection leading to organ failure), or sepsis (extreme reaction to infection in the body).

• Anoxic encephalopathy (cessation of blood flow into the brain).

• Cardiopulmonary arrest (sudden loss of heart function, lung function, or breathing).

• Airway obstruction.

• Pneumonia (inflammation of the air sacs caused by lung infection).

• Intubation (obtaining airway by inserting a tube into the trachea).

• Pulmonary edema (excessive fluid build-up in the lungs).

• Cellulitis (serious skin infection caused by bacteria).

• Death.

• Hypoxia (lack of enough oxygen in the body).

• Tracheal stenosis (narrowing of the airway or trachea, causing breathing difficulties).

• Tracheostomy is a surgical procedure to obtain airway passage for smooth breathing.

• Toxic shock syndrome (a life-threatening complication caused by bacterial infection).

What Are the Differential Diagnosis for Tracheitis?

The condition can be mimicked by various medical conditions, such as:

• Angioedema.

• Amyloidosis.

• Candidiasis (tracheal or laryngeal).

• Deep neck space infection.

• Caustic ingestion.

• Epiglottitis.

• Diphtheria.

• Fungal laryngitis or tracheitis.

• Laryngeal hematoma.

• Wegner granulomatosis (Granulomatosis with polyangiitis).

• Laryngeal trauma.

• Laryngopharyngeal reflux (LPR).

• Laryngomalacia.

• Laryngotracheobronchitis.

• Malignancy (laryngeal, esophageal, thyroidal, or tracheal).

• Leukoplakia

• Adenocarcinoma.

• Follicular thyroid cancer.

• Anaplastic thyroid cancer.

• Lymphoma.

• Melanoma.

• Medullary thyroid cancer.

• Metastasis.

• Squamous cell carcinoma.

• Thymic carcinoma.

• Papillary thyroid cancer.

• Thymoma.

• Peritonsillar abscess.

• Necrotizing sialometaplasia.

• Pseudoepitheliomatous hyperplasia.

• Sarcoidosis.

• Retropharyngeal abscess.

• Tracheal compression.

• Tracheal stenosis.

• Subglottic stenosis.

• Tracheostomy-induced granulation.

• Tracheomalacia.

• Tuberculosis.

• Tracheostomy obstruction.

• Vocal fold paresis/paralysis.

• Viral laryngitis or tracheitis.

Conclusion

To conclude, tracheitis is an uncommon but very serious complication that has life-threatening outcomes. The condition is mainly seen in children but can also affect immunocompromised adults undergoing tracheostomy or mechanical ventilation. The condition causes airway obstruction caused by a serious viral infection in the chest, followed by a bacterial infection, leading to swelling in the trachea. The condition has serious outcomes but can be effectively managed with timely diagnosis and treatment, and the prognosis can be good in most children with almost complete recovery.