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[Bacterial tracheitis due to Haemophilus influenzae]
R Porta Ribera1, M Renom Llonch, C Moreno Eguilaz
1Servicios de PediatríaInstitut Universitari Dexeus, Barcelona, Spain.
Insights
Bacterial tracheitis, a severe croup mimic, requires prompt diagnosis and treatment. This case highlights Haemophilus influenzae as a cause, emphasizing its potential severity and the need for consideration in difficult croup cases.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
Background:
- Bacterial tracheitis is a rare but serious upper airway infection.
- It often presents with symptoms mimicking severe croup, posing diagnostic challenges.
Observation:
- A 6.5-year-old girl presented with severe croup, high fever, and upper respiratory symptoms.
- Initial treatments for croup were ineffective, necessitating intubation.
- Thick, purulent tracheal secretions and a normal epiglottis suggested bacterial tracheitis.
Findings:
- Diagnosis was confirmed by isolating Haemophilus influenzae from tracheal secretions.
- The patient received intravenous ceftriaxone and mechanical ventilation.
- Fever and purulent secretions persisted for 5 days despite treatment.
Implications:
- Bacterial tracheitis should be considered in the differential diagnosis of severe croup unresponsive to standard treatment.
- Prompt identification and appropriate antibiotic therapy are crucial for managing this potentially life-threatening condition.
- Successful management involves a multidisciplinary approach including respiratory support and antimicrobial stewardship.
Abstract:
We present a case of bacterial tracheitis in a 6.5 year old girl. Clinical signs and symptoms consisted of severe croup with high grade fever, which were preceded by upper respiratory tract prodrome. Initial treatment with steroids and nebulized epinephrine was unsuccessful. The patient was intubated a few hours after admission. Thick purulent secretions emerging from the trachea and the normal appearance of the epiglottis suggested the diagnosis of bacterial tracheitis, which was confirmed by isolation of Haemophilus influenzae in the culture of the tracheal secretions. The patient was administered a 14 day course of endovenous ceftriaxone and was kept on mechanical ventilation for 7 days. Fever and purulent tracheal secretions continued for the next 5 days. After 48 hours without these signs, laryngotracheobronchoscopy ruled out residual obstruction. Extubation was successfully performed. Fourteen days later physical examination showed no abnormalities and the patient was discharged. No complications were found during followup. The clinical, diagnostic and therapeutic aspects of this potentially life threatening entity that should taken into account in the differential diagnosis of severe croup are discussed.