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Roger Jones, MD; José I. Santos, MD; James C. Overall, Jr, MD

JAMA. 1979;242(8):721-726.

Abstract
During a 14-month period, eight infants and children were observed with an acute, infectious, upper airway obstructive disease with features common to both croup and epiglottitis. We have termed this distinct entity "bacterial tracheitis." All patients failed to respond to treatment for croup, including racemic epinephrine delivered by intermittent positive-pressure breathing. Direct laryngoscopy consistently revealed a normal epiglottis and aryepiglottic folds but marked subglottic mucosal edema. Tracheal suctioning yielded copius mucopus below the subglottic swelling. Gram stain of this material corroborated subsequent cultures: Staphylococcus aureus, six; group A Streptococcus, one; and Haemophilus influenzae (not typed), one. All patients required periodic tracheal suctioning for relief of upper airway obstruction. Six patients required endotracheal intubation; one required a tracheostomy. Bacterial tracheitis should be considered in the differential diagnosis of a young child with a croup-like illness that is refractory to conventional therapy.

(JAMA 242:721-726, 1979)

Author Affiliations
From the Primary Children's Medical Center and the Departments of Anesthesiology (Dr Jones) and Pediatrics (Drs Santos and Overall), University of Utah College of Medicine, Salt Lake City.

Footnotes
Read in part before the 18th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, Oct 4, 1978.

Reprint requests to Division of Infectious Diseases, Department of Pediatrics, University of Utah College of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132 (Dr Overall).

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