Epiglottitis? Think Tracheitis too!

• Considered bacterial tracheitis in a patient who has fever, stridor, and symptoms that does not respond to therapy for croup (racemic epinephrine and steroids).
• Additionally, that toxic appearing child that you think looks like the textbook picture of epiglottitis, may actually have bacterial tracheitis.

• The epidemiology of acute infectious upper airway disease in pediatrics has been altered with immunization against Haemophilus influenza-b and the widespread use of corticosteroids for the treatment of viral croup.
• Bacterial tracheitis has replaced epiglottitis and croup as the most common cause of acute respiratory failure.  One study found it to be 3 times more likely to cause respiratory failure than croup and epiglotittis combined.
• The mortality rates had been reported as high as 18% to 40%.

Hopkins, A., et al., Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics, 2006. 118(4): p. 1418-21