During a 14-month period, eight infants and children were observed with an acute, infectious, upper airway obstructive disease with features common to both croup and epiglottitis. We have termed this distinct entity "bacterial tracheitis." All patients failed to respond to treatment for croup, including racemic epinephrine delivered by intermittent positive-pressure breathing. Direct laryngoscopy consistently revealed a normal epiglottis and aryepiglottic folds but marked subglottic mucosal edema. Tracheal suctioning yielded copius mucopus below the subglottic swelling. Gram stain of this material corroborated subsequent cultures: Staphylococcus aureus, six; group A Streptococcus, one; and Haemophilus influenzae (not typed), one. All patients required periodic tracheal suctioning for relief of upper airway obstruction. Six patients required endotracheal intubation; one required a tracheostomy. Bacterial tracheitis should be considered in the differential diagnosis of a young child with a croup-like illness that is refractory to conventional therapy.
(JAMA 242:721-726, 1979)