Tracheitis And Pharyngitis

Infections of pharynx and trachea

Pharyngitis

Tracheitis (pseudomembranous croup)

1. Pharyngitis

An acute inflammation of the pharynx is called "pharyngitis". This is either produced by a viral or bacterial infection. There may just be painful swallowing and a sore throat, but there may be a membrane in the back of the throat and lymph node swelling underneath the chin. The physician may want to take a throat culture as it can be difficult to know whether this clinical entity is due to a virus or bacterium.

The organisms isolated can be group A Streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae and on occasion even gonorrhea.

Treatment:

This consists initially of penicillin V 250 mg four times daily for 10 days until the culture report comes back. This way rheumatic fever from group A Streptococcus can be avoided.

The final culture report may sway the physician to change the therapy according to the sensitivity testing (Ref. 4).

2. Pseudomembranous Croup (=Tracheitis)

This condition happens mostly in children and the onset is usually very acute. It can be caused by a number of bacteria such as Haemophilus influenzae, Staphylococcus aureus or group A beta hemolytic streptococcus.

Symptoms:

There is a typical stridor (a high pitched sound with breathing) and a croupy cough (typical bark-like cough). This comes from a narrowing of the trachea because of acute swelling of the lining of the trachea.

There may also be a high fever, lots of pussy secretions and difficulties getting a breath. This is an emergency and warrants a call to 911(Emergency ambulance team) to get the child to the nearest hospital. If the breathing deteriorates, an emergency intubation or tracheotomy may have to be done.

Treatment:

The pediatric ENT specialist will likely do a direct laryngoscopy for inspecting and diagnosing the condition. Alternatively a lateral X-ray of the trachea would show the subglottic narrowing due to a purulent membrane. Antibiotic coverage against the common bacteria mentioned above is initiated intravenously, such as cefuroxime. When the culture report becomes available this can be adjusted according to the sensitivity testing. Antibiotics are given for a prolonged course of 2 or 3 weeks. Delayed treatment leads to complications such as sepsis, retropharyngeal cellulitis or abscess formation, or bronchopneumonia. With prompt treatment none of these complications will occur.

Infections Overview

Respiratory Infection

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. The Merck Manual: Bacterial Tracheitis

2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.

3. F Charatan BMJ 2000 Oct 21;321(7267):980.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 43.

5. JR Zunt and CM Marra Neurol Clinics Vol.17, No.4,1999: 675-689.

6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 162.

7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.

8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.

9. DO Freedman et al. Med Clinics N. Amer. Vol.83, No 4 (July 1999): 865-883.

10. SP Fisher-Hoch et al. J Virol 2000 Aug; 74(15): 6777-6783.

13. PE Sax: Infect DisClinics of N America Vol.15, No 2 (June 2001): 433-455.

14. David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.

Last Modified: Feb. 14, 2012