What is acute tracheitis?

What is acute tracheitis?

Respiratory tract infections are very common in childhood and are the main cause of airway inflammation, with viral infections being especially common. Tracheitis, an inflammation of the trachea, is a more frequent pathology in children than in adults.

When we speak of tracheitis, we refer to the acute infection of the trachea, while the term croup refers to symptoms originating from inflammation in the larynx and subglottic airway. However, this term has been used to describe a variety of respiratory conditions in children such as laryngitis, laryngotracheitis, laryngotracheo, bronchitis, bacterial tracheitis, or spasmodic croup.

What are the causes of tracheitis?

The most common cause is inflammation of the trachea due to infection. The origin of infectious tracheitis can be viral or bacterial.

virus infection

  • Parainfluenza
  • Influenza
  • respiratory syncytial virus
  • Adenovirus
  • Coronavirus o virus herpes

Except for herpes viruses, viral laryngotracheitis is common during fall and winter epidemics.

bacterial infection

  • Micoplasma pneumoniae
  • Staphylococcus aureus
  • Stretococcus pneumoniae o pyogenes
  • Haemophilus influenzae

Tracheitis of bacterial origin, therefore, should be treated with antibiotics . These are secondary infections, that is, they appear during a viral tracheitis that is complicated by this superinfection.

What are the symptoms depending on the type of infection?

The clinical presentation of tracheitis, tracheobronchitis, and bacterial tracheitis depends on the type of infection and the degree of upper airway obstruction. Stridor is the most characteristic sign of tracheal obstruction.

If there is bacterial superinfection , then it can progress to bacterial laryngotracheitis, which is more serious and can have complications, such as the formation of pseudomembranes that can cover part of the upper airway, the trachea, and even affect the bronchi. Stridor is the most characteristic sign of tracheal obstruction.


It is the most common in children between 3 months and 3 years. It is characterized by a gradual onset clinic:

  • Starts with symptoms of a common cold (runny nose, nasal congestion)
  • It progresses in the next 12 to 48 hours to a dry cough, hoarseness, fever, and stridor.
  • Respiratory difficulty will increase as the upper airway obstruction increases.

The picture resolves between three to seven days. The presence of respiratory distress is an indicator of the severity and progression of the obstruction and should always be evaluated in the emergency department.


The inflammation affects the trachea and extends to the bronchi , being a more serious condition than laryngotracheitis alone. If it gets complicated it can lead to pneumonia . The usual symptoms are:

  • Symptoms of laryngotracheitis
  • Symptoms and signs of bronchial involvement such as wheezing with increased respiratory distress.

Bacterial tracheitis or bacterial croup

Although the most frequent origin is usually bacterial superinfection after a viral infection, it is not uncommon for it to present as a primary bacterial infection, especially in patients who have required endotracheal intubation or tracheostomy.

  • It starts with the same symptoms of upper airway involvement for about 3 days.
  • More severe symptoms such as stridor, cough, shortness of breath, and fever appear later.

Pseudomembranous tracheitis

It is characterized by a pseudomembrane that partially or completely covers the tracheobronchial tree and that produces a greater obstruction of the airway. It can be a serious complication of bacterial tracheitis or it can occur in immunocompromised patients. It can be caused by bacteria or fungi, such as Aspergillus or The clinic is similar to that of bacterial tracheitis, but more serious, with greater respiratory difficulty, very high fever and very poor general condition.


Which is the treatment?

Most cases are mild and self-limited, so they can be successfully treated on an outpatient basis and followed by the pediatrician at the health center. However, if the pediatrician detects warning signs or seriousness, the child must be transferred to a hospital.

There is no specific treatment for those of viral aetiology. The therapy is focused on reducing inflammation in the airways, providing respiratory support and maintaining a correct state of hydration.

The most widely used pharmacological treatment is antipyretics and adrenaline or inhaled corticosteroids . In the most severe cases, oral or intramuscular corticosteroids, bronchodilators (when there is bronchial involvement) and antibiotics can be administered if a bacterial cause or superinfection is suspected. In the most severe cases, hospital admission may be required.

What you should know…

  • When we talk about tracheitis we refer to the acute infection of the trachea.
  • The most common cause is inflammation of the trachea due to infection. The origin of infectious tracheitis can be viral or bacterial.
  • Most cases are mild and self-limited, so they can be successfully treated on an outpatient basis and followed by the pediatrician at the health center.
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