Bacterial laryngotracheobronchitis as one cause of airway obstruction in older children

Abstract

Laryngitis, tracheitis and bronchitis is a common, usually self-limiting viral infection. Bacterial laryngitis, tracheitis and bronchitis is caused by secondary bacterial infection of a viral laryngeal infection leading to a mucopurulent exudate that can cause acute upper airway obstruction and eventually lead to a life-threatening condition. Bacterial tracheitis should be considered in the differential diagnosis of any child with acute upper airway obstruction. This diagnosis should also be considered in any child with viral croup that does not respond to conventional treatment. The correct way to definitively diagnose bacterial tracheitis is by direct visualisation of the trachea by bronchoscopy, but this may not be necessary in all cases. Management includes close observation and monitoring, early initiation of broad-spectrum antibiotics, pain management, and clearing the airways of lingering secretions. The decision to secure an airway by intubation or tracheotomy should be made on an individual basis depending on the severity of symptoms and the patient’s condition. If diagnosed early and treated properly, complete recovery can be expected. We present two patients diagnosed with laryngotracheobronchitis, in whom a correct diagnosis allowed successful recovery.