Bacterial tracheitis (pseudomembianous croup) is a severe life threatening form of laryngo tracheo bronchitis, tracheitis is relatively more common as a cause of a pediatric airway emergency requiring admission to the pediatric intensive care unit.
The diagnosis must be high in the differential when a patient present with severe upper airway obstruction and fever.
CAUSE :- The organism most often isolated is S aureus, but organisms such as H injluenzae, group A Streptococcus pyogenes, Neisseria species, Moraxella catarrhalis, and others have been reported. A viral prodrome is common. Viral coinfections are described and influenza should be treated.
The disease probably represents localized mucosal invasion of bacteria in patients with primary viral croup, resulting in inflammatory edema, purulent secretions, and pseudomembranes. Although cultures of the tracheal secretions are frequently positive, blood cultures are almost always negative.
- CLINICAL FINDINGS: The early clinical picture is similar to that of viral croup. However, instead of gradual improvement, patients develop higher fever, toxicity, and progressive or intermittent severe upper airway obstruction that is unresponsive to standard croup therapy. The incidence of sudden respiratory arrest or progressive respiratory failure is high, requiring airway intervention.
- LABORATORY FINDINGS: Imaging The white cell count is usually elevated with a left shift. Cultures of tracheal secretions usually demonstrate one of the causative organisms. Lateral neck radiographs show a normal epiglottis but severe subglottic and tracheal narrowing. Irregularity of the contour of the proximal tracheal mucosa can frequently be seen radiographically and should elicit concern for tracheitis. Bronchoscopy showing a normal epiglottis and the presence of copious purulent tracheal secretions and membranes confirms the diagnosis.
ACONITUM NAPELLUS - Red, dry, constricted, numb, prickling, burning, stinging. Tonsils swollen and dry Hoarse, dry, croupy cough; loud, labored breathing. Child grasps at throat every time he coughs. Very sensitive to inspired air. Shortness of breath. Larynx sensitive. Stitches through chest. Cough, dry, short, hacking; worse at night and after midnight
BELLADONNA- Dry, as if glazed; angry-looking congestion (Ginseng); red, worse on right side. Tonsils enlarged; throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Œsophagus dry; feels contracted. Spasms in throat.
BRYONIA ALBA- Dryness, sticking on swallowing, scraped and constricted (Bell). Tough mucus in larynx and trachea, loosened only after much hawking; worse coming into warm room.
PHOSPHORUS- Larynx very painful. Clergyman's sore throat; violent tickling in larynx while speaking. Aphonia, worse evenings, with rawness. Cannot talk on account of pain in larynx. Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough.
ANTIMONIUM TARTARICUM- Great rattling of mucus, but very little is expectorated. Velvety feeling in chest. Burning sensation in chest, which ascends to throat. Rapid, short, difficult breathing; seems as if he would suffocate; must sit up
CARBO VEGETABLES- Cough with itching in larynx; spasmodic with gagging and vomiting of mucus. Whooping cough, especially in beginning. Deep, rough voice, failing on slight exertion. Hoarseness; worse, evenings, talking; evening oppression of breathing, sore and raw chest. Wheezing and rattling of mucus in chest
HEPAR SULPHUR- sensation as if a plug and of a splinter in throat. Quinsy, with impending suppuration. Stitches in throat extending to the ear when swallowing. Hawking up of mucus.