Acute tracheitis is a possible cause of an acute airway obstruction caused mainly by a secondary bacterial infection. This potentially life-threatening condition is preceded by an upper respiratory tract viral illness and features symptoms of both epiglottitis and croup. The diagnosis is achieved by the patient's history, physical exam, and the relevant studies.
Acute tracheitis, the possible cause of an acute airway obstruction, is caused by a bacterial infection and the subsequent production of mucopurulent exudates . This disease affects young children and infants although there have been case reports of adult patients   . Acute tracheitis is typically preceded by croup or other upper respiratory tract viral illnesses and hence is the most prevalent in the winter . Possibly, there is a predilection for males but related data are variable in the literature . Some of the main bacterial agents implicated in this disease include Moraxella catarrhalis, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, H1N1 influenza virus , and Haemophilus influenzae type B.
The clinical presentation of acute tracheitis shares manifestations with epiglottitis and croup. The prodromal upper respiratory tract illness consists of fever, cough, rhinorrhea, and sore throat . Notable features of acute tracheitis include high fever, dyspnea, tachypnea, stridor, cough, and a hoarse voice   . The condition of a patient with acute tracheitis may deteriorate rapidly secondary to the airway obstruction. In these cases, there is a risk for respiratory distress which will warrant emergency care. With an early recognition of acute tracheitis and adequate medical care, patients are expected to make a full recovery without long-term consequences .
While pneumonia is the most common complication of acute tracheitis , patients may be at risk for developing less frequent sequelae such as acute respiratory distress syndrome (ARDS), pulmonary edema, and septic shock .
Patients with acute tracheitis exhibit a toxic appearance . Additionally, they demonstrate remarkable exam findings such as inspiratory stridor and possibly expiratory stridor, retractions, bark-like cough, and cyanosis. Vital sign changes are indicative of respiratory distress.
The diagnosis of acute tracheitis is based on the patient's history, physical exam, and the appropriate studies. It's important to note that patients with croup-like manifestations not responding to the standard treatment should be suspected to have acute tracheitis.
A complete blood count (CBC) with differential may reveal leukocytosis in addition to a left shift . Blood cultures should also be obtained although they are mainly negative .
Neck radiography (the anteroposterior view) demonstrates subglottic narrowing  . Additionally, the lateral view may show the haziness and irregularities of the anterior tracheal wall.
Chest X-ray in at least half of cases will yield findings indicative of pneumonia which complicates the clinical picture   .
Laryngotracheobronchoscopy is indicated in some patients for direct airway visualization and definitive diagnosis. Confirmatory findings include a narrowed subglottic region, erythematous airway, laryngotracheal inflammation, and exudative tracheal secretions. The epiglottis will usually appear normal or mildly affected . This procedure also enables a therapeutic and diagnostic tracheal toilet in which secretions can be removed and sent for a culture.
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