What Is Tracheitis? Information for Parents

Tracheitis is an infection of the windpipe (trachea) that makes breathing difficult. A rare but serious complication of an upper respiratory tract infection, it is more common in children—their smaller tracheas are more easily blocked by swelling.

Tracheitis symptoms include a cough similar to croup, fever, and wheezing. It may also cause a blue tinge to lips, nails, and skin—a dangerous sign that the body is not getting enough oxygen.

Tracheitis is a medical emergency. Children with tracheitis may need a temporary breathing tube (intubation), treatment in the intensive care unit (ICU), and intravenous (IV) antibiotics.

This article discusses tracheitis. It explains the causes and symptoms of trachea infections, their treatment, and signs requiring emergency care.

Causes of Tracheitis

Tracheitis often begins as a viral infection of the upper airways, which sets the stage for a secondary bacterial infection. Bacteria most commonly involved in tracheitis include:

• Staphylococcus aeureus 
• Streptococcus pneumoniae
• Moraxella catarrhalis
• Haemophilus influenzae type B (HiB)
• Haemophilus influenzae 

Tracheitis is rare: It only occurs in about one in 1 million upper respiratory infections. It is most common in children between ages 3 to 8 and occurs more often in boys. This is because children have a smaller windpipe that is more easily blocked by swelling.

Tracheitis is much less common in adults, but the risk is higher in those who have HIV/AIDS, a weak immune system, or diabetes. It can occur from a tracheostomy, a procedure that creates a breathing hole in the trachea through the neck, and mechanical ventilator use.

While bacteria is often the culprit, fungal infections, such as Aspergillus and Zygomycetes, can cause tracheostomy-associated tracheitis. Most adult cases of tracheitis occur in patients who are already hospitalized.

Symptoms of Tracheitis

Symptoms of tracheitis vary from person to person and may include:

• Cough that sounds “croupy,” and the child may cough up secretions
• Breathing difficulties
• Stridor when breathing in (common)
• Wheezing when breathing out (uncommon)
• High fever, usually greater than 102 F
• Blue lips (a sign of cyanosis or low oxygen levels), if the ability to breathe is deteriorating

Tracheitis is a life-threatening condition that requires medical attention. If your child is experiencing stridor or cyanosis, seek emergency medical treatment or call 9-1-1.

How to Tell the Difference Between Tracheitis and Croup

A “croupy cough” is a hallmark symptom of viral croup that may also be present in tracheitis. It is often described as “barking,” “brassy,” or resembling a seal’s bark.

This cough makes it easy to confuse the two illnesses. The following features can help distinguish tracheitis from croup.

How Is Tracheitis Diagnosed?

Tracheitis is a diagnosis based on symptom history, physical examination, and testing. Diagnostic tests that your healthcare provider may perform include:

• The measurement of oxygen levels in the blood (pulse oximetry)
• A culture of sputum from the trachea collected during a laryngoscopy, which can then be analyzed in the lab to determine the infectious agent causing your symptoms
• An X-ray of the lungs and breathing passageways

During these procedures, your healthcare provider will be using the findings to help differentiate from epiglottitis, another relatively rare disorder that may require rescue interventions for breathing.

How Is Tracheitis Treated?

Aggressive treatment early on is important in properly managing tracheitis. Initial treatments will usually require admission into an ICU and may include the following:

Laryngoscopy

Laryngoscopy is an exam of the back of your throat. This can be done while awake using a tool with a small mirror and a light.

In some cases, a more advanced laryngoscopy may be needed. This is done under general anesthesia and uses a tube called a laryngoscope.

During this procedure, your healthcare provider will clear secretions and membranes from the airway to prevent obstruction.

Intubation

A breathing tube may be placed (intubated) to improve oxygen intake in people with tracheitis. A breathing tube will allow the ICU nurses to perform aggressive airway suctioning to keep breathing as comfortably as possible.

Antibiotics

Tracheitis requires treatment with IV antibiotics for five to six days, followed by oral antibiotics for 10 to 14 days of treatment. Antibiotic regimens commonly used to treat tracheitis include:

• Amoxicillin-clavulanic acid
• Ampicillin-sulbactam
• Ceftriaxone plus nafcillin or vancomycin
• Clindamycin plus a third-generation cephalosporin
  

People who are allergic to those antibiotics may be treated with vancomycin or clindamycin plus levofloxacin or ciprofloxacin. If cultures come back resistant to these antibiotics, they may be changed to a different regimen.

Antifungals

In the case of fungal tracheitis infections like Aspergillus or Zygomycetes, treatment includes IV antifungal medications, such as Vfend IV (voriconazole).

Summary

Tracheitis is a rare, life-threatening infection of the trachea. More common in children ages 3 to 8, it can also occur in adults who have a tracheostomy, are immunocompromised, or are on a ventilator. 

In children, tracheitis is usually a complication of a viral chest infection. A secondary bacterial infection can occur, causing airway swelling that restricts breathing. In adults, tracheitis can be due to a bacterial or fungal infection. 

Symptoms of tracheitis—a croup-like cough, fever, difficulty breathing, stridor, wheezing, and cyanosis—warrant immediate medical attention. 

In many cases, children with tracheitis will require a breathing tube and close monitoring in the ICU. IV antibiotics or antifungal medications are needed to clear the infection. 

With prompt treatment, most children with tracheitis make a complete recovery.