Bacterial Tracheitis: a case of severe upper airway obstruction in a previously healthy adult female
CCCF ePoster library. Ovtcharenko N. 11/12/19; 283443; EP77 Disclosure(s): None
Dr. Natalia Ovtcharenko
Dr. Natalia Ovtcharenko
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Abstract
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ePoster
Topic: Clinical Case Report

Ovtcharenko, Natalia1; Rocca, Nicole2; Bilbily, Matthew3; Bridge, Suzanne4
1Department of Medicine, Queen's University, Kingston, Canada
2Department of Emergency Medicine, Queen's University, Kingston, Canada
3Department of Anesthesia, Queen's University, Kingston, Canada
4Department of Critical Care, Queen's University, Kingston, Canada
 


Background
Bacterial tracheitis is a condition often associated with infection in young children, where it is well recognized as a cause of upper airway obstruction (1). In adults, however, tracheitis is a much rarer presentation and is less commonly considered in the differential diagnosis of stridor. Previous case reports in immunocompetent hosts have demonstrated mild infections treatable with antibiotics. More complicated presentations have been described in immunocompromised patients (2,3). Only one case has been previously described in an otherwise well patient who required mechanical ventilation, which was in the context of pregnancy (4).

Objectives
This case reviews an immunocompetent patient presenting to hospital with stridor secondary to severe bacterial tracheitis causing critical airway obstruction requiring mechanical ventilation. It highlights challenges in diagnosis and strategies for management.

Methods
A review of the literature was performed of Medline, Embase and Cochrane to identify previously published cases. Chart review and case report was completed on the patient's presentation in collaboration with the multidisciplinary team managing their care. Patient consent was obtained and the project was approved by the Queen's University Health Sciences Research Ethics Board.

Results
A 75-year-old, immunocompetent patient presented to hospital with acute dyspnea developing over 7 days, on the background of mild dyspnea on exertion over the previous 4 months. Significant increase in work of breathing as well as stridor suggested upper airway obstruction, however laryngoscopy demonstrated normal epiglottis and supraglottic airway. Further laryngoscopy by ENT demonstrated severe subglottic stenosis and urgent intubation was planned in collaboration with anesthesia and ENT. The patient was successfully intubated with Glidescope and a 5.0 microlaryngoscopy tube. Bronchoscopy demonstrated edema of the trachea which extended 5cm requiring deep insertion of the endotracheal tube. The patient was treated with ceftriaxone and azithromycin for community acquired bacterial tracheitis and extubated after 7 days.

Discussion
Upper airway obstruction is an airway emergency requiring rapid assessment and management. Diagnosis with laryngoscopy considering both the supra- and subglottic airways is essential. Early involvement of anesthesia and ENT is important for timely intervention. Awake intubation in the OR is recommended with tracheostomy setup available.
Bacterial tracheitis is a rare but important diagnosis to include on the differential for upper airway obstruction in otherwise healthy patients.
 


References

  1. Blot M, Bonniaud-Blot P, Favrolt N, Bonniaud P, Chavanet P, Piroth L. Update on childhood and adult infectious tracheitis. Med Mal Infect [Internet]. 2017;47(7):443–52. Available from: http://dx.doi.org/10.1016/j.medmal.2017.06.006
  2. Musher DM, Kubitschek KR, Crennan J, Baughn RE. Pneumonia and acute febrile tracheobronchitis due to Haemophilus influenza. Ann Intern Med. 1983;99(4):444–50.
  3. Johnson JT, Liston SL. Bacterial Tracheitis in Adults. Arch Otolaryngol Neck Surg. 1987;113(2):204–5.
  4. Sholapurkar SL, Slack RWT, Avery AF, Tonge HM, Dunster GD. Acute tracheitis with severe upper airway obstruction complicating pregnancy. BJOG An Int J Obstet Gynaecol. 2002;109(2):221–2.
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