Tracheitis or pseudomembranous croup occurs mostly in children and the onset is usually very acute. It can be caused by a number of bacteria such as Haemophilus influenzae, Staphylococcus aureus or group A beta hemolytic streptococcus.
There is a typical stridor (a high pitched sound with breathing) and a croupy cough (typical bark-like cough). This comes from a narrowing of the trachea because of acute swelling of the lining of the trachea.
There may also be a high fever, lots of pussy secretions and difficulties getting a breath. This is an emergency and warrants a call to 911(Emergency ambulance team) to get the child to the nearest hospital. If the breathing deteriorates, an emergency intubation or tracheotomy may have to be done.
The pediatric ENT specialist will likely do a direct laryngoscopy for inspecting and diagnosing the condition. Alternatively a lateral X-ray of the trachea would show the subglottic narrowing due to a purulent membrane. Antibiotic coverage against the common bacteria mentioned above is initiated intravenously, such as cefuroxime. When the culture report becomes available this can be adjusted according to the sensitivity testing. Antibiotics are given for a prolonged course of 2 or 3 weeks. Delayed treatment leads to complications such as sepsis, retropharyngeal cellulitis or abscess formation, or bronchopneumonia. With prompt treatment none of these complications will occur.
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