Tracheitis is a bacterial or viral infection of the trachea. This type of infection mainly affects:
- small children (rarely in the first 6 months of life),
- Teenagers up to 14 years.
What is the trachea?
The trachea is an important part of the respiratory tract.
If air enters through the nose or mouth, it enters the trachea via the larynx (where the vocal cords are located).
Further down, this organ divides into two tubes (bronchi), through which the air reaches the lungs directly. The trachea:
- transports oxygen to the lungs,
- removes carbon dioxide from the body when exhaling.
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Causes of tracheitis
As a rule, bacterial tracheitis is caused by Staphylococcus aureus. But there are also other bacteria that can cause this infection:
- Streptococcus pneumoniae
- Klebsiella pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
Often bacterial tracheitis develops after an acute viral infection of the respiratory tract, such as:
- cold,
- Croup.
The viral disease is thought to cause transient local or systemic changes in the immune response, predestining the patient for bacterial infection.
Viruses that can provoke this disease are:
- rhinoviruses,
- Parainfluenza viruses.
After a respiratory infection, the bacteria easily penetrate the trachea and cause:
- Infection
- inflammation,
- Swelling.
In addition to these causes of tracheitis, there are other factors that irritate the throat:
- Gastroesophageal reflux can irritate the throat and airways.
- The smoke from cigarettes, in this case, tracheitis can often recur.
- Chemical substances in the air that irritate the trachea.
- Allergens that provoke allergic tracheitis.
What are the symptoms of bacterial tracheitis?
Bacterial tracheitis often follows an upper respiratory tract infection.
The initial symptoms (acute phase) are the following:
- cough,
- sore throat,
- mild fever.
After two to five days, further symptoms develop:
- deep, productive and severe cough,
- chest pain behind the sternum,
- difficult breathing,
- high fever,
- enlarged lymph nodes,
- noisy breathing (wheezing),
- Cyanosis: a bluish discoloration of the skin as a sign of lack of oxygen.
Concomitant symptoms and diseases of tracheitis:
- pharyngitis,
- laryngitis (in this case, the patient also suffers from hoarseness),
- Cold.
A wheezing sound (stridor) can be a sign of a serious infection, as it means that the airways are partially narrowed: this situation is potentially dangerous.
Complications of tracheitis
- Airway obstruction: can lead to death
- Bronchitis
- Pneumonia
- Pneumothorax
- Pulmonary edema
- Septic shock
- Respiratory distress syndrome
- Toxic shock syndrome: is possible only if the infection is caused by the bacterium Staphylococcus.
Diagnosis of tracheitis
The doctor can diagnose this condition by a physical examination and listening (auscultation) of the lungs to detect signs of respiratory failure. To confirm the diagnosis and rule out other health problems, the doctor may order further examinations.
These investigations include:
- oxygen saturation: indicates how much oxygen is dissolved in the blood;
- nasopharyngeal swab: a sample of the secretion is taken from the upper pharynx to examine it for bacteria;
- X-ray of the trachea, which makes the following problems visible:
- Narrowing in the area under the glottis
- Opacity and irregularities of the anterior tracheal wall (less common)
- Bronchoscopy, which reveals inflammation and purulent secretions.
Differential diagnosis
The doctor must exclude:
- laryngitis (inflammation of the larynx),
- pneumonia (inflammation of the lungs),
- Bronchitis (inflammation of the bronchial tree).
These diseases can also occur together.
How is it treated? Therapy for tracheitis
Treatment of bacterial tracheitis consists in the following measures:
In the respiratory tract
Make sure that the child does not get upset.
If the patient’s breathing deteriorates, an oxygen mask is helpful.
If intubation is necessary, an endotracheal tube of size 1.7 mm is used.
The diameter is smaller than the standard measure to minimize trauma in the inflamed area below the glottis.
Antibiotic therapy for bacterial tracheitis
The following protocol is from Bandar Al-Mutairi of the Pediatric Respiratory Medicine and Department of Paediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta.
Broad-spectrum intravenous antibiotics should be given as soon as diagnosis is made.
A third-generation cephalosporin in conjunction with penicillin is the most appropriate treatment.
In some cases, vancomycin may also be necessary.
In addition, if anaerobic bacteria cause the infection, the doctor may prescribe:
- clindamycin,
- Metronidazole.
In particular, this may be necessary in children in whom the therapy does not work with:
- cephalosporin,
- Penicillin.
The recommended cycle for the antibiotics is 10 to 14 days (intravenously or orally).
Intravenous therapy can be interrupted if:
- the child has been fever-free for at least 48 hours;
- the discomfort of the trachea has disappeared;
- the voice has returned to normal.
To curb inflammation, the doctor may prescribe:
- corticosteroids, for example, an aerosol containing beclometasone (Ventolair),
- Cough suppressants (mucolytics) such as ambroxol (AmbroHexal).
Before taking these drugs in pregnancy, it is definitely necessary to consult the doctor.
When is intubated?
As a rule, the doctor inserts an endotracheal tube into the trachea through the mouth or nose if:
- there is a serious obstruction;
- the patient’s condition worsens and the results of the examination may not arrive in time.
Young children are more likely to be intubated because they have narrower airways.
The average duration of intubation is 3.2 days (between 1.5 and 7.6 days).
The indications for removal of the tube (extubation) are:
- reduction of fever,
- decrease in tracheal secretions,
- healthier appearance,
- Fluid occurrences or secretions around the endotracheal tube (an indication that tracheal swelling has decreased).
Respiratory physiotherapy can help expel the secretions from coughing.
Surgery
Only rarely is a tracheotomy necessary.
A tracheotomy is essential if the endotracheal tube cannot be inserted.
The bronchial toilet is facilitated by a tracheal cannula.
Natural remedies for tracheitis
Natural remedies for irritation of the trachea include inhalations (steam) over boiling water with:
- Bicarbonate
- eucalyptus essential oil.
In closed and heated rooms, a humidifier should be used to increase humidity.
Gargling with propolis, which has an antibacterial effect, is also useful, especially if the patient also suffers from a sore throat.
Recovery times and prognosis for patients with bacterial tracheitis
Recovery from this disease depends on treatment.
The airways of young children quickly swell and make breathing difficult.
Tracheitis can be dangerous, because when the trachea is completely occluded, death from respiratory arrest occurs.
The mortality rate has declined significantly in recent years because:
- therapy with broad-spectrum antibiotics is started immediately;
- aggressive techniques are used to clear the airways.
According to scientific studies, the average hospital stay is between 3 and 12 days.
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