What Is Bacterial Tracheitis?

Medically Reviewed by Dan Brennan, MD on February 20, 2024
3 min read

Bacterial tracheitis is also known as bacterial croup or acute laryngotracheobronchitis. It is a rare but often life-threatening upper airway disease that almost always occurs in children. Rapid and effective treatment is essential. The majority of children who have this disease need to be admitted to an intensive care unit.

Bacterial tracheitis is an infection of your trachea. The trachea, or windpipe, is found at the top of your airway and connects your voice box to the large airways, or bronchi, below.

Usually, bacterial tracheitis happens after an upper respiratory infection like the flu, measles, or parainfluenza. Viruses like these can cause damage to the membrane of the trachea, leaving the body sensitive to infection. However, typically healthy children will recover quickly if they are diagnosed and treated early.

Children who are immunocompromised are often susceptible to bacterial tracheitis. This is especially true if the child has a long-term tracheostomy, a tube that is inserted into someone’s trachea to deliver oxygen to the lungs after an injury, reduce swelling of the throat, or prevent fluid or food from entering the lungs.

Children with a tracheostomy must receive the proper care to prevent bacterial infection. Care should include daily cleanings of the inner cannula and monthly cleanings of the whole tube.

Bacterial tracheitis has been found to occur in children ages 3 to 8.  It is most common in the autumn and winter months when colds and flu are widespread.

Usually, bacterial tracheitis symptoms begin as any other viral upper respiratory infection. This stage typically lasts for one to three days and then gives way to more severe symptoms. However, some children can start to show severe signs of bacterial tracheitis straight away. These symptoms are:

  • Harsh vibrating noises from the larynx when they breathe
  • Fever
  • Cough
  • Thick mucus
  • Drooling
  • Respiratory muscle contractions 
  • Fatigue

Usually, bacterial tracheitis is diagnosed by looking at the trachea after the child presents signs of the disease.

Children with compromised immune systems will often need to get a fiber cable installed within their trachea to help them breathe.  This procedure is known as a bronchoscopy. However, not all patients get bronchoscopies. They are done on a need basis. Still, younger children often need them the most because their airways are so small.

Other, less severe cases can be treated by supplemental oxygen. In addition, patients may also receive 10 to 14 days of antiviral medication. This is very effective for children who have had the flu before they get bacterial tracheitis. However, antiviral medications in themselves are not proven treatments for bacterial tracheitis.

Children usually take between three and 12 days in the hospital to recover. Usually, they recover with no permanent damage. However, there are cases in which children exhibit a subtle narrowing of their airways. This occurs after a patient has gotten any sort of tubular assistance in breathing.

Between 2% and 3% of all cases end in death. Usually, this happens when children go into respiratory failure combined with:

  • Cardiac arrest
  • Deficiency of oxygen to the brain
  • Acute respiratory distress syndrome
  • Excess fluid in the lungs
  • Toxic shock syndrome
  • Collapsed lungs due to air or gas in the lung cavity
  • Septic shock

Treatment typically involves a medical team consisting of:

  • An anesthesiologist (who cares for patients before, during, and after surgery)
  • An otolaryngologist (who specializes in treating diseases of the head and neck)
  • An infectious disease expert
  • An intensive care doctor

The children will need extensive monitoring in multiple ways. Some patients may need longer or more intensive therapies while others may be able to leave the hospital in a matter of days.

The monitoring of immunocompromised children will be far more intensive than other children. Typically, this condition is prevented by vaccination for measles, influenza, and other viral infections. Vaccination is especially important for children with compromised immune systems.