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[Laryngitis revealing bacterial tracheitis in a five-year-old child]
G de Bilderling1, E Bodart, D Tuerlinckx
1Service de pédiatrie, cliniques universitaires de Mont-Godinne, université catholique de Louvain, avenue Thérasse, 5530 Yvoir, Belgique. Georges.Debilderling@pedi.ucl.ac.be
Insights
This case report highlights bacterial tracheitis in a child initially presenting with croup and pneumonia. Early bronchoscopy is crucial for diagnosis in unresponsive cases.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Croup and pneumonia can present with overlapping symptoms, complicating diagnosis in pediatric patients.
- Incomplete response to standard treatments like inhaled adrenaline and dexamethasone warrants further investigation.
Observation:
- A five-year-old boy exhibited symptoms of croup and left lower lobe pneumonia with significant respiratory distress.
- Laryngoscopy revealed mild glottic and subglottic inflammation.
- Bronchoscopy identified thick pus in the left lower lobe, leading to intubation and pus removal.
Findings:
- Tracheal fluid culture confirmed the presence of Haemophilus influenzae.
- The patient was diagnosed with bacterial tracheitis, though tracheal involvement was not initially prominent.
Implications:
- This case underscores the importance of considering bacterial tracheitis in children with severe or unresponsive croup.
- Laryngoscopy and bronchoscopy are vital diagnostic tools for lower respiratory tract infections in pediatric patients.
- Prompt and accurate diagnosis through specialized procedures can guide appropriate antibiotic therapy and improve patient outcomes.
Case Report:
We report the case of a five-year-old boy with clinical features of croup and left lower lobe pneumonia. Response to inhaled adrenaline and dexamethasone was incomplete and he developed respiratory distress. Direct laryngoscopy performed in the operating room showed mild glottic and subglottic inflammation. On bronchoscopy, there was thick pus coming from the left lower lobe. He was intubated for three days and regular toilet brought back thick pus. Tracheal fluid culture grew Haemophilius influenzae.
Comments:
We suggest that he had bacterial tracheitis but that the tracheal involvement was not prominent at the time of diagnosis.
Conclusion:
Laryngoscopy and bronchoscopy in specialized surroundings should be considered for each child with croup unresponsive to conventional treatment, especially in case of lower respiratory tract involvement.