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Martin-Loeches I, Sganzerla Martinez G, Garduno A, Cusack R, Andaluz-Ojeda D, Lopez-Campos G, Kelvin D, Ramirez P, Lomas Lorenzo LT, Socias Crespi L, Bermejo-Martín JF. Transcriptomics reveals shared immunosuppressive landscapes in ventilator-associated lower respiratory tract infections (VA-LRTI) patients. Expert Rev Anti Infect Ther 2023; 21:1135-1141. [PMID: 37676034 DOI: 10.1080/14787210.2023.2256979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) represents a transitory status of immunoparalysis, and we hypothesized that ventilator-associated tracheobronchitis (VAT) could share also some degree of immune response to a respiratory infection. RESEARCH DESIGN AND METHODS A prospective observational study in five medical ICUs to evaluate immunological alterations of patients with VA-LRTI. Immunological gene expression profiles in the blood using whole transcriptome microarrays in the first 24 hours following diagnosis. The area under the receiver operating characteristic curve (AUROC) was used to assess the accuracy of mRNA levels to differentiate VA-LRTI and lack of infection. A principal component analysis (PCA) was employed for analyzing the impact of each genetic expression footprint variable in explaining the variance of the cohort. RESULTS There was overlapping between the three classes of patients encompassing gene expression levels of 8 genes (i.e. HLA, IL2RA, CD40LG, ICOS, CCR7, CD1C, CD3E). HLA-DRA was equally low among VAT and VAP patients characterizing immune depression, and significantly lower than the control group. CONCLUSIONS Our findings suggest that VAP and VAT are not so different regarding gene expression levels suggesting a degree of immunosuppression. Our results indicate a state of immunoparalysis in respiratory infections in critically ill patients.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
- CIBER de Enfermedades Respiratorias, CB22/06/00035, Instituto de Salud Carlos III, Madrid, Spain
| | - Gustavo Sganzerla Martinez
- Laboratory of Immunity, Department of Immunology, Shantou University Medical College, Shantou, China
- Laboratory of Emerging and Infectious Diseases, Department of Immunology and Microbiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexis Garduno
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
| | - Rachel Cusack
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Leinster, Ireland
| | - David Andaluz-Ojeda
- Servicio de Medicina Intensiva, Hospital Universitario HM Sanchinarro, Hospitales Madrid, Madrid, Spain
- Intensive Care Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
- Scientific Coordination, Fundación de Investigación HM, Madrid, Spain
| | - Guillermo Lopez-Campos
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - David Kelvin
- Laboratory of Immunity, Department of Immunology, Shantou University Medical College, Shantou, China
- Laboratory of Emerging and Infectious Diseases, Department of Immunology and Microbiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paula Ramirez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico la Fe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Valencia, Spain
| | | | | | - Jesús F Bermejo-Martín
- Group for Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación Biomédica de Salamanca, (IBSAL), Gerencia Regional de Salud de Castilla y León, Salamanca, Spain
- School of Medicine, Universidad de Salamanca, Salamanca, Spain
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, CIBERes, Barcelona, Spain
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Kawakami N, Ito M, Takahashi K, Moriya T, Saito H, Wakai Y, Saito K. Pseudomembranous Tracheobronchitis With Severe Tracheal Stenosis and Masked Bronchial Obstruction. J Emerg Med 2021; 60:e39-e44. [PMID: 33353810 DOI: 10.1016/j.jemermed.2020.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudomembranous tracheobronchitis (PMTB) is a rare condition characterized by the formation of endobronchial pseudomembranes. PMTB overlaps with necrotizing tracheobronchitis or plastic bronchitis. The reported infectious etiology mainly includes invasive aspergillosis. PMTB can cause serious airway obstruction; however, urgent tracheotomy is rarely required. CASE REPORT A 46-year-old woman was transferred to the emergency department (ED) with a 1-week history of progressive dyspnea and cough that was preceded by fever and sore throat. She was previously healthy except for a 20-year history of mild palmoplantar pustulosis. Stridor was evident. Nasolaryngoscopy performed in the ED revealed severe tracheal stenosis caused primarily by mucosal edema and secondarily by pseudomembranes. Initially, tracheitis was considered the sole cause of dyspnea. Although she underwent urgent tracheotomy to prevent asphyxia, her respiration deteriorated progressively. Bronchoscopy revealed massive pseudomembranes obstructing the bilateral bronchi, which led to the clinical diagnosis of PMTB. Subsequent toilet bronchoscopy markedly improved her ventilation. The causative pathogen was not identified despite extensive work-up, including molecular biological testing. Histopathologic examination of the pseudomembranes revealed fibrin with abundant neutrophils, which was consistent with PMTB. Associated conditions, including immunodeficiency, were not found. Her condition improved with antibiotics and repeated toilet bronchoscopy. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: PMTB is an important differential diagnosis of airway emergencies. PMTB can present with critical edematous tracheal stenosis and masked bronchial pseudomembranous obstruction. Emergency physicians should include PMTB in the differential diagnosis in adult patients with acute central airway obstruction because it requires prompt multimodal treatment.
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Affiliation(s)
- Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masaru Ito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuhiko Takahashi
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomohiro Moriya
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroaki Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoko Wakai
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuhito Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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Gaudet A, Devos M, Keignart S, Pouly O, Lecailtel S, Wallet F, Nseir S. Usefulness of Sepsis-3 in diagnosing and predicting mortality of ventilator-associated lower respiratory tract infections. PLoS One 2021; 16:e0245552. [PMID: 33444395 PMCID: PMC7808583 DOI: 10.1371/journal.pone.0245552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Early distinguishing ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) remains difficult in the daily practice. However, this question appears clinically relevant, as treatments of VAT and VAP currently differ. In this study, we assessed the accuracy of sepsis criteria according to the Sepsis-3 definition in the early distinction between VAT and VAP. METHODS Retrospective single-center cohort, including all consecutive patients with a diagnosis of VAT (n = 70) or VAP (n = 136), during a 2-year period. Accuracy of sepsis criteria according to Sepsis-3, total SOFA and respiratory SOFA, calculated at time of microbiological sampling were assessed in differentiating VAT from VAP, and in predicting mortality on ICU discharge. RESULTS Sensitivity and specificity of sepsis criteria were found respectively at 0.4 and 0.91 to distinguish VAT from VAP, and at 0.38 and 0.75 for the prediction of mortality in VA-LRTI. A total SOFA ≥ 6 and a respiratory SOFA ≥ 3 were identified as the best cut-offs for these criteria in differentiating VAT from VAP, with sensitivity and specificity respectively found at 0.63 and 0.69 for total SOFA, and at 0.49 and 0.7 for respiratory SOFA. Additionally, for prediction of mortality, a total SOFA ≥ 7 and a respiratory SOFA = 4 were identified as the best-cut-offs, respectively yielding sensitivity and specificity at 0.56 and 0.61 for total SOFA, and at 0.22 and 0.95 for respiratory SOFA. CONCLUSIONS Sepsis criteria according to the Sepsis-3 definition show a high specificity but a low sensitivity for the diagnosis of VAP. Our results do not support the use of these criteria for the early diagnosis of VAP in patients with VA-LRTI.
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Affiliation(s)
- Alexandre Gaudet
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection et d’Immunité de Lille, Lille, France
| | - Matthieu Devos
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
| | - Sylvain Keignart
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
| | - Olivier Pouly
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
| | - Sylvain Lecailtel
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
| | | | - Saad Nseir
- Department of Intensive Care Medicine, Critical Care Center, CHU Lille, Lille, France
- Team Fungal Associated Invasive & Inflammatory Diseases, Lille Inflammation Research International Center, INSERM U995, Université de Lille, Lille, France
- * E-mail:
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Pidaparti V, Keilman A, Case J, Thomas A. Pediatric Emergency Medicine Simulation Curriculum: Bacterial Tracheitis. MedEdPORTAL 2020; 16:10946. [PMID: 32875092 PMCID: PMC7449579 DOI: 10.15766/mep_2374-8265.10946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/30/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Pediatric bacterial tracheitis is a rare but life-threatening upper airway infection with mortality rates estimated as high as 20%, typically affecting children between 6 months and 12 years old. Given such high mortality rates, we felt it was important to train medical personnel to evaluate and manage this condition. METHODS This simulation-based curriculum was developed for health care professionals involving the evaluation and management of an 8-year-old male with symptoms of fever, stridor, worsening barking cough, and increased work of breathing. Critical actions included identifying stridor and airway respiratory distress; monitoring and supporting airway, breathing, and circulation; administering racemic epinephrine and dexamethasone; and identifying and treating bacterial tracheitis as the underlying cause. Scenario-specific debriefing tools were put together to elicit scenario feedback and aid in formative learning. RESULTS The scenario was conducted with six fellows and 12 residents and medical students. Per the survey data, the case was rated as highly relevant (median = 5) and highly realistic (median = 5) by participants on a 5-point Likert scale. DISCUSSION Pediatric bacterial tracheitis is a low frequency, but high-risk scenario that was amenable to simulation as an educational modality and was well-received by participants. The debriefing tools were implemented as a means of helping instructors customize the scenario for learners based on respective educational backgrounds and learning styles.
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Affiliation(s)
- Vaidehi Pidaparti
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Ashley Keilman
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
| | - Jennifer Case
- Resident, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital
| | - Anita Thomas
- Assistant Professor, Department of Pediatric Emergency Medicine, University of Washington School of Medicine and Seattle Children's Hospital
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5
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Lam RPK, Wong KW, Wan CK. Allergic contact dermatitis and tracheobronchitis associated with repeated exposure to tear gas. Lancet 2020; 396:e12. [PMID: 32673597 DOI: 10.1016/s0140-6736(20)31560-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/15/2020] [Accepted: 06/25/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Wong Chuk Hang, Hong Kong Special Administrative Region, China.
| | - Kin Wa Wong
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; 24-hour Outpatient and Emergency Department, Gleneagles Hong Kong Hospital, Wong Chuk Hang, Hong Kong Special Administrative Region, China
| | - Chi Kin Wan
- Department of Medicine, Gleneagles Hong Kong Hospital, Wong Chuk Hang, Hong Kong Special Administrative Region, China
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Abstract
We present two cases of coronavirus disease 2019 (COVID-19)-related laryngotracheitis in good-prognosis, ventilated patients who had failed extubation. As the pandemic continues to unfold across the globe and better management of those with respiratory failure develops, this may be an increasingly common scenario. Close ENT-intensivist liaison, meticulous team preparation, early consideration of rigid endoscopy and prospective data collection and case sharing are recommended.
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Affiliation(s)
- Charles Matthew Oliver
- Departments of Anaesthesia and Intensive Care Medicine, Royal Free Hampstead NHS Trust Hospital, London, nw3 2qg, UK
- Division of Surgery and Interventional Science, University College London, London, W1W 7TS, UK
- University College London Hospitals NHS Trust, London, NW1 2BU, UK
| | - Marta Campbell
- Departments of Anaesthesia and Intensive Care Medicine, Royal Free Hampstead NHS Trust Hospital, London, nw3 2qg, UK
| | - Oma Dulan
- Departments of Anaesthesia and Intensive Care Medicine, Royal Free Hampstead NHS Trust Hospital, London, nw3 2qg, UK
| | - Nick Hamilton
- University College London Hospitals NHS Trust, London, NW1 2BU, UK
- Ear Institute, University College London, London, WC1X 8EE, UK
- NIHR Biomedical Research Centre, University College London Hospitals, London, UK
| | - Martin Birchall
- University College London Hospitals NHS Trust, London, NW1 2BU, UK
- Ear Institute, University College London, London, WC1X 8EE, UK
- NIHR Biomedical Research Centre, University College London Hospitals, London, UK
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7
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Pina-Maiquez I, García-Lujan R, Revuelta-Salgado F, Margallo-Iribarnegaray J, de Miguel-Poch E. Aspergillus Tracheobronchitis. The Diagnostic Value of Endoscopic Imaging. Arch Bronconeumol 2020; 57:226. [PMID: 31902632 DOI: 10.1016/j.arbres.2019.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/17/2019] [Accepted: 11/19/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Isabel Pina-Maiquez
- Unidad de Endoscopia Respiratoria, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Ricardo García-Lujan
- Unidad de Endoscopia Respiratoria, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Fernando Revuelta-Salgado
- Unidad de Endoscopia Respiratoria, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Juan Margallo-Iribarnegaray
- Unidad de Endoscopia Respiratoria, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Eduardo de Miguel-Poch
- Unidad de Endoscopia Respiratoria, Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
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Peter Frings D, Simon M, Kluge S. Aspergillus Tracheobronchitis in Influenza B. Dtsch Arztebl Int 2019; 116:100. [PMID: 30892194 PMCID: PMC6435861 DOI: 10.3238/arztebl.2019.0100b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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9
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Guttmann A, Pillinger MH, Krasnokutsky S. Autoimmune Tracheal Cartilage Inflammation Responsive to Anti-TNF-α Therapy. Bull Hosp Jt Dis (2013) 2018; 76:139-142. [PMID: 29799374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Tracheal inflammation, or tracheitis, is a pathologic process that can occur secondary to a number of systemic inflammatory diseases, or it may be idiopathic in nature. Regardless of the underlying etiology, tracheitis can, in its most severe form, be life-threatening, thus making its treatment an area of interest. Our case is one of a 50-year-old man with a remote history of inflammatory bowel disease achieving clinical cure following surgical resection who presented with progressive dyspnea due to tracheal stenosis that was presumed secondary to an autoimmune and inflammatory etiology. His disease was initially refractory to recurrent surgical interventions. He ultimately achieved clinical improvement with a combination of methotrexate and the tumor necrosis factor alpha (TNF-α) inhibitor, adalimumab. While both clinical trials and standardized treatment guidelines are lacking in this domain, this case illustrates a potential role for TNF-α inhibitors in the treatment of inflammatory tracheitis, irrespective of the underlying etiology.
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Abstract
OBJECTIVE: Bacterial tracheitis (BT) is a condition that can cause fatal airway obstruction. We evaluated our experience with BT over a 10-year period. STUDY DESIGN: Retrospective review of patients treated for BT between 1991 and 2001. RESULTS: Ninety-four cases were evaluated. The mean patient age was 7.9 years. At presentation, 60% were afebrile, and the mean WBC count was 10.8 × 103/mm3. Only 53% of patients required intubation. Younger children were more likely to require this intervention. S. aureus was the most commonly cultured bacteria, while isolation of M. catarrhalis was associated with a higher intubation rate. A pathologic virus was isolated in 64% of the 34 cultures performed. Only 9 patients were described as “toxic,” and 6 presented in respiratory extremis. There were no deaths. CONCLUSION AND SIGNIFICANCE: A subset of patients with tracheal membranes has a less severe clinical appearance. Nonetheless, these patients require debridement and aggressive medical treatment. We propose that the term “exudative tracheitis” (ET) better describes this entity. Older patients who are less systemically ill and rapidly respond to local and systemic therapy are characteristic of ET. EBM rating: C.
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Affiliation(s)
- Frank N Salamone
- Division of Otolaryngology and Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Ohio 45229-3039, USA
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Hansen M, Meckler G, Lambert W, Dickinson C, Dickinson K, Guise JM. Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services. Am J Emerg Med 2016; 34:599-601. [PMID: 26818155 PMCID: PMC4799729 DOI: 10.1016/j.ajem.2015.12.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/01/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Matthew Hansen
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Garth Meckler
- Division of Pediatric Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William Lambert
- Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Caitlin Dickinson
- Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA
| | - Kathryn Dickinson
- Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA
| | - Jeanne-Marie Guise
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR, USA; Department of Obstetrics & Gynecology, Oregon Heath & Science University, Portland, OR, USA; Department of Medical Informatics & Clinical Epidemiology, Oregon Heath & Science University, Portland, OR, USA
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12
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Mattioni J, Portnoy JE, Moore JE, Carlson D, Sataloff RT. Laryngotracheal mucormycosis: Report of a case. Ear Nose Throat J 2016; 95:29-39. [PMID: 26829683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Airway mucormycosis is a deadly opportunistic infection that affects immunocompromised persons, particularly diabetics and those undergoing chemotherapy. Although it is typically a pulmonary or sinonasal infection, mucormycosis can affect the larynx and trachea, with devastating results. We report the case of a 46-year-old man with human immunodeficiency virus infection, hepatitis C infection, neurosyphilis, and recently diagnosed Burkitt lymphoma who presented with dysphonia and stridor after receiving one dose of intrathecal chemotherapy. Flexible laryngoscopy detected the presence of fibrinous material that was obstructing nearly the entire glottis. Surgical debridement revealed a firm mucosal attachment; there was little bleeding when it was removed. After debridement, the patient's dyspnea improved only to recur 2 days later. After an awake tracheotomy, laryngoscopy and bronchoscopy identified necrosis extending from the supraglottic area to the carina tracheae. Biopsies demonstrated hyphal architecture consistent with mucormycosis. Despite continued debridements, the fibrinous material reaccumulated. The patient was placed in hospice care; his airway remained patent, but he died from other causes several weeks after presentation. The management of airway mucormycosis is challenging and complex. Fungal airway infections should be considered in the differential diagnosis of an immunosuppressed patient who presents with dyspnea, dysphonia, and vocal fold immobility. Timely diagnosis and management are critical for a successful outcome, although the prognosis is poor if the infection is widespread, even with the best of efforts.
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Affiliation(s)
- Jillian Mattioni
- Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, 219 N. Broad St., Philadelphia, PA 19107, USA
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Hiyoshi M, Kawai K, Shibuya M, Ozawa T, Kishikawa J, Nirei T, Tanaka T, Tanaka J, Kiyomatsu T, Tada T, Kanazawa T, Kazama S, Shoda H, Sumitomo S, Kubo K, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Yamamoto K, Watanabe T. Tracheobronchitis with dyspnea in a patient with ulcerative colitis. Intern Med 2015; 54:749-53. [PMID: 25832936 DOI: 10.2169/internalmedicine.54.3142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 42-year-old man with a one-year history of ulcerative colitis who presented with exacerbated bloody diarrhea, a productive cough and increasing breathing difficulties. Colonoscopy revealed typical deep ulcers in the rectosigmoid colon and atypical multiple sucker-like ulcers in the transverse colon, and computed tomography of the chest demonstrated wall thickening of the trachea and bronchi. In addition, bronchoscopy showed ulcers in the trachea, and histopathology disclosed findings of necrosis and inflammation of the subepithelial tissue of the trachea. Based on these findings, the patient's respiratory symptoms were strongly suspected to be due to ulcerative colitis-related tracheobronchitis. Treatment with systemic corticosteroids subsequently resulted in a rapid clinical improvement.
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Affiliation(s)
- Masaya Hiyoshi
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital; 2.Department of Surgical Oncology, Faculty of Medical Sciences, the University of Tokyo, Japan
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14
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Tilve SS, Shah AB, Prabhudesai PP, Tampi C. An unusual case of invasive Aspergillus ulcerative tracheobronchitis without involvement of lung parenchyma in a post-renal transplant patient. Indian J Chest Dis Allied Sci 2013; 55:221-223. [PMID: 24660566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present the case of a 54-year-old male, who presented with respiratory complaints four months after he underwent renal transplantation. Bronchoscopy showed ulcerated mucosa of the left main bronchus and computed tomography (CT) of the thorax showed foci of air within the bronchial wall. A biopsy from the lesion showed septate fungal hyphae, dichotomously branching at acute angles. A locally invasive Aspergillus ulcerative tracheobronchitis with no parenchymal involvement is an important cause of tracheobronchitis in post-renal transplant patients. An early diagnosis and institution of appropriate treatment can improve the outcome. A combination treatment of caspofungin and voriconazole can be considered if patient is not responding to voriconazole alone.
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15
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O'Niel MB, Chun RH, Conley SF. Ulcerative lesions as a rare cause of laryngotracheitis in the pediatric population. Am J Otolaryngol 2013; 34:541-4. [PMID: 23535210 DOI: 10.1016/j.amjoto.2013.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/15/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The goal of this study is to describe a unique finding of ulcerative lesions of the larynx in two pediatric patients presenting with prolonged acute laryngotracheitis and compare to previously described reports to determine the typical clinical picture, need for intervention, and management model. METHODS We present two cases of ulcerative lesions of the larynx in immunocompetent children, one with PCR positive HSV, which presented as severe croup requiring intensive care unit admission. Literature review was completed to assess for current knowledge of this entity. Our cases are discussed in the context of previously reported cases of HSV laryngotracheitis. Descriptive analysis was completed focusing on presentation, physical exam findings, treatment, length of therapy, and outcomes. RESULTS Literature review uncovered six case reports including 10 individual cases of prolonged croup with findings of HSV laryngitis and one retrospective review describing 15 cases of prolonged croup found to be caused by ulcerative laryngitis. All patients underwent direct laryngoscopy and bronchoscopy for evaluation. Analysis was completed comparing the studies to our patients with significant findings including high intubation rate of 77%, ulcerative stomatitis in 63%, and treatment with antiviral medication directed at HSV in 85% with improvement in symptoms. CONCLUSION It is important to consider HSV as a possible pathogen in cases of prolonged or atypical croup. Laryngoscopy should be used for diagnostic intervention and identification of ulcerative lesions. Stomatitis may be an indication for earlier direct inspection. Treatment with anti-viral therapy and with discontinuation or taper of steroid is suggested.
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Affiliation(s)
- Mallory B O'Niel
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, and Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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16
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Craven DE, Hudcova J, Lei Y. Diagnosis of ventilator-associated respiratory infections (VARI): microbiologic clues for tracheobronchitis (VAT) and pneumonia (VAP). Clin Chest Med 2012; 32:547-57. [PMID: 21867822 PMCID: PMC7126692 DOI: 10.1016/j.ccm.2011.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intubated patients are at risk of bacterial colonization and ventilator-associated respiratory infection (VARI). VARI includes tracheobronchitis (VAT) or pneumonia (VAP). VAT and VAP caused by multidrug-resistant (MDR) pathogens are increasing in the United States and Europe. In patients with risk factors for MDR pathogens, empiric antibiotics are often initiated for 48 to 72 hours pending the availability of pathogen identification and antibiotic sensitivity data. Extensive data indicate that early, appropriate antibiotic therapy improves outcomes for patients with VAP. Recognizing and treating VARI may allow earlier appropriate therapy and improved patient outcomes.
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Affiliation(s)
- Donald E Craven
- Center for Infectious Disease & Prevention, Lahey Clinic Medical Center, Burlington, MA 01805, USA.
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17
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Hearp ML, Jakowski JD. The chance identification of unusual-appearing bacteria in bronchoalveolar lavage fluid. Acta Cytol 2012; 56:104-6. [PMID: 22236754 DOI: 10.1159/000331574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND A well-known indication for the cytologic examination of bronchoalveolar lavage (BAL) fluid is the identification of infectious organisms. However, an important distinction must be made as to whether the organisms seen represent a true opportunistic lower respiratory tract infection or a non-pathologic contamination. CASE We describe herein the case of a 13-month-old male infant who presented with persistent chest congestion and tracheobronchitis and who underwent BAL as part of his clinical work-up. On cytological examination of the BAL fluid, the Romanowsky-stained cytospin slides contained numerous squamous epithelial cells with some showing rare striated rod-like structures on their surfaces. The peculiar structures also had rounded ends and were very large when compared to adjacent known bacterial cocci. CONCLUSION We have determined that the striated rod-like structures in the infant's BAL fluid were indeed bacteria, Simonsiella sp. Simonsiella has reportedly been found in up to 32% of oral swabs in normal humans and it is considered a commensal and non-pathogenic organism. The characteristically large size, the association with normal oral-derived squamous cells and the striated appearance is diagnostic and will hopefully eliminate any possibility of confusion with a truly pathogenic organism.
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Affiliation(s)
- Matthew L Hearp
- Brody School of Medicine at East Carolina University, Greenville, NC, USA
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18
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Abstract
Dysphonia in patients with bronchial asthma is generally ascribed to vocal-cord abnormalities or steroid myopathy secondary to inhaled corticosteroids. Herein, we report the case of a 55-year-old male patient - a diagnosed case of bronchial asthma being on inhaled corticosteroids - who presented with dysphonia and was diagnosed to be suffering from Aspergillus laryngotracheobronchitis.
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19
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[The state of the larynx in children following repeated and recurrent croup]. Vestn Otorinolaringol 2011;:31-3. [PMID: 22433683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The obstructive forms of laryngitis and/or laryngotracheitis are the emergency conditions in the pediatric practice that frequently necessitate hospitalization of the affected patients. According to R.J. Rosychuk and co-workers, such patients make up to 6% of the total number of children admitted to stationary clinics. The authors discuss the problem of recurrent catarrhal croup in the children and its differential diagnosis from other diseases. The results of endoscopic and virological examination of the children with repeated or recurring croup are discussed. The children of this group most frequently present with infections by respiratory syncytial and parainfluenza viruses. The endoscopic examination has revealed various forms of chronic laryngitis in 21 (42%) children, subacute (including reactive) laryngitis in 8 (16%), and the developing nodules in the vocal cords of 15 (30%) patients. Six (12%) patients experienced a change of the quality of voice in the absence of structural alterations in the larynx (functional dysphonia). It is concluded that the results of endoscopic and virological examination do not correlate with one another.
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20
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Abstract
We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. However, the second patient survived. Aspergillus tracheobronchitis should be considered in immuno-compromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.
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Affiliation(s)
- Shang-Miao Chang
- Chest Division, Department of Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung-San N Road, Taipei, Taiwan
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21
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Pokhabova EI, Starkov IG, Krutikov MG. [Bronchoscopy in diagnostics and treatment of burn tracheobronchitis]. Khirurgiia (Mosk) 2009:52-56. [PMID: 19798775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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22
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Abstract
A 19-year-old Japanese man who had been diagnosed with Crohn's disease (CD) suffered from dry cough and fever over 38 degrees C for three days prior to hospitalization. On admission, his colonic CD condition was stable, neither active nor in remission. Computed tomography of the chest showed small elevated tracheobronchial lesions. Bronchoscopy showed diffuse whitish granular lesions in the trachea and bronchi. The pathological findings in the biopsy showed inflammatory infiltration suggesting Crohn's tracheobronchitis. Thereafter, he was treated with inhaled Fluticasone propionate 400 microg/day. After one week his dry cough improved, and after two weeks bronchoscopic findings were improved.
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Affiliation(s)
- Takashi Asami
- Division of General Medicine, Clinical Department of Internal Medicine, Saitama Medical Center, Jichi Medical University, Saitama
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23
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Beck N, Folia M, Mahy S, Duvillard C, Chanteret C, Lecomte H, Gazzano E, Piroth L, Romanet P. [Acute group A beta-hemolytic streptococcus membranous laryngotracheobronchitis in an adult]. Ann Otolaryngol Chir Cervicofac 2008; 125:318-322. [PMID: 19012876 DOI: 10.1016/j.aorl.2008.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 09/23/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea. METHODS We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation. RESULTS The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment. CONCLUSION Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.
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Affiliation(s)
- N Beck
- Service d'otorhinolaryngologie, de chirurgie cervicofaciale et de phoniatrie, hôpital Général, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon cedex, France.
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24
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Affiliation(s)
- James D Cherry
- Division of Infectious Diseases, Mattel Children's Hospital UCLA, and the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1752, USA.
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25
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Affiliation(s)
- Mamatha Bhat
- Department of Internal Medicine, McGill University Health Centre, Montréal, Que
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26
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Carrel T, Gygax E, Jenni HJ, Wagner B. Successful extracorporeal life support using a new micro-diagonal pump in a child with acute laryngotracheobronchitis, lung failure, and untractable septic shock. J Thorac Cardiovasc Surg 2007; 133:824-5. [PMID: 17320602 DOI: 10.1016/j.jtcvs.2006.09.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 09/08/2006] [Accepted: 09/20/2006] [Indexed: 11/24/2022]
Affiliation(s)
- Thierry Carrel
- Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland.
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27
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Abstract
A 44-year-old Korean male died of rapidly progressive respiratory failure and refractory hypoxemia in 8 days after being admitted with a fever and dyspnea. The patient was diagnosed with pseudomembranous necrotizing tracheobronchial aspergillosis by fibroptic bronchoscopy and it was not related to an invasion of the pulmonary parenchyma. To the best of our knowledge, this case represents a patient with pseudomembranous necrotizing tracheobronchial aspergillosis that developed in an immunocompetent host, rapidly resulting in airway obstruction with acute respiratory failure and refractory hypoxemia without an invasion of the pulmonary parenchyma.
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Affiliation(s)
- Hyo-Jeong Oh
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Hak-Ryul Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki-Eun Hwang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - So-Young Kim
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Sun-Ho Ahn
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Sei-Hoon Yang
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun-Taik Jeong
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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28
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Lekomtseva OI, Sharaev PN. [A role of determination of sialic acids in the biological fluids of children with stenosing laryngotracheitis]. Klin Lab Diagn 2006:46-7. [PMID: 16875131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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29
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Affiliation(s)
- William J Janssen
- University of Colorado Health Sciences Center, 4200 East Ninth Ave, Box C-272, Denver, CO 80262, USA.
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30
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Abstract
Despite the advances that have been achieved in supportive pediatric intensive care, tracheitis remains a significant cause of reversible upper-airway obstruction in pediatric patients. This discussion highlights the epidemiology and clinical presentation of tracheitis in the twenty-first century and reviews diagnostic and therapeutic modalities. The gold standard for therapy remains supportive airway management in conjunction with appropriate antibiotic therapy. Finally, the unique challenges of diagnosis and treatment of tracheitis in the technology dependent child with an existing artificial airway (endotracheal tube or tracheostomy) are addressed.
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Affiliation(s)
- Jeanine Graf
- Baylor College of Medicine, Houston, TX 77030, USA.
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31
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Tasci S, Glasmacher A, Lentini S, Tschubel K, Ewig S, Molitor E, Sauerbruch T, Lüderitz B, Rabe C. Pseudomembranous and obstructiveAspergillustracheobronchitis - optimal diagnostic strategy and outcome. Mycoses 2006; 49:37-42. [PMID: 16367817 DOI: 10.1111/j.1439-0507.2005.01180.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pseudomembranous and obstructive Aspergillus tracheobronchitis (PMATB/OATB) are still considered to be refractory to therapy and to have a fatal outcome. To evaluate the optimal diagnostic strategy and to describe factors affecting the outcome of PMATB and OATB. Retrospective analysis of four new cases of PMATB and OATB combined with 16 previously reported cases over a 10-year period (1995-2004). Among the four new cases reported and the 16 published cases, four patients survived their infection. The mortality rate was significantly higher in the group of ventilated patients [94% (15 of 16 patients)] than in the group of non-ventilated patients [25% (1 of 4 patients), P < 0.05, Fisher's exact test]. In all 20 patients, diagnosis was established by bronchoscopy. Culture examination of mucous plugs was positive in 8 of 10, culture of the tracheobronchial aspirate was positive in 8 of 12, and bronchoalveolar lavage was diagnostic in 7 of 13 patients. All bronchoscopic techniques were complementary in improving the yield of bronchoscopy. However, microscopy of mucous plugs and/or necrotic material was the best diagnostic modality [positive in 94% (17 of 18 patients)]. Prognosis of PMATB and OATB remains poor. Microscopy of respiratory specimens is the most sensitive tool to confirm the diagnosis. The characteristic appearance of the disease makes it possible to start antifungal therapy immediately.
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Affiliation(s)
- Selçuk Tasci
- Department of Internal Medicine II, University of Bonn, Germany.
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32
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Affiliation(s)
- Steven M Selbst
- Division of Emergency Medicine, AI duPont Hospital for Children, Wilmington, DE 19899, USA.
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33
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Abstract
George Washington died in the winter of 1799 from acute epiglottitis during an epidemic of influenza. The details of the illness were fully recorded by his secretary, Tobias Lear, and this is the first published description in English of this condition. An account is given of the medical treatment and controversies that arose in criticism of the attendant doctors.
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34
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Ahmed KA, Thompson JW, Joyner RE, Stocks RMS. Airway obstruction secondary to tracheobronchial involvement of asymptomatic undiagnosed Crohn's disease in a pediatric patient. Int J Pediatr Otorhinolaryngol 2005; 69:1003-5. [PMID: 15911023 DOI: 10.1016/j.ijporl.2005.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Accepted: 02/02/2005] [Indexed: 01/02/2023]
Abstract
Tracheal involvement in Crohn's disease is extremely rare and can present with airway obstruction in any age group, including the pediatric patient. We describe the case of a 9-year-old female who presented with a 2-week history of intermittent stridor, resolving temporarily with the administration of systemic steroids. The patient denied any abdominal complaints and was otherwise healthy. Bronchoscopy revealed progressive tracheal inflammation necessitating an urgent tracheotomy. Subsequent laboratory investigation confirmed the diagnosis of Crohn's disease. This is the first reported case of previously undiagnosed Crohn's disease presenting with airway manifestations.
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Affiliation(s)
- Khwaja Asif Ahmed
- University of Tennessee Health Sciences Center, Department of Otolaryngology-Head and Neck Surgery, 963 Court Ave, Suite B227, Memphis, TN 38163, USA.
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35
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Kinebuchi SI, Oohashi K, Takada T, Moriyama H, Yoshizawa H, Kobayashi O, Suzuki E, Gejyo F. Tracheo-bronchitis associated with Crohn's disease improved on inhaled corticotherapy. Intern Med 2004; 43:829-34. [PMID: 15497519 DOI: 10.2169/internalmedicine.43.829] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We report a case of tracheo-bronchitis in Crohn's disease. A 23-year-old Japanese woman who had been diagnosed with Crohn's disease three years previously was hospitalized. She had been suffering from dry cough for one month. Computed tomography of the chest revealed marked thickening of the tracheal wall. Bronchoscopy showed erythematous and edematous mucosa with diffuse whitish granular lesions in the trachea and bronchi. The bronchial biopsy specimens showed non-specific inflammatory infiltrates consisting of lymphocytes and plasma cells, and hyperplasia of bronchial glands. Inhaled corticotherapy, fluticasone propionate 800 microg/day, was effective for both the inflammatory mucosa and thickened tracheal wall.
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Affiliation(s)
- Shin-ichi Kinebuchi
- Division of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata
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36
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García-Casillas MA, Matute JA, Sanz E, Cerdá J, Bernardo B, Sánchez O, Molina E, Sánchez Luna M, Vázquez J. [Diagnosis and management of necrotizing tracheobronchitis]. Cir Pediatr 2004; 17:93-7. [PMID: 15285593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients. MATERIAL AND METHODS In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results. RESULTS All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months. CONCLUSIONS Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.
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37
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Abstract
While irritation of the tracheal mucosa is a common finding after laryngectomy, specific hypersensitivity to tracheal tubes or their components is extremely rare and has only been documented as a contact allergy. In this case report, we present type I hypersensitivity to tracheal tube components for the first time. The patient regularly used a special silicone tube for swimming after laryngectomy and complained about increasing tracheal irritation during and after the use of this tube. A standard skin prick test with common aeroallergens and a skin patch test with standard, rubber and adhesive allergens as well as with parts of the silicone tube was performed. Different parts of the tracheal tube were also tested with a scratch test. Total IgE as well as specific IgE for latex allergens was measured. Both skin prick and patch tests were negative. No specific IgE for latex allergens was detected. The scratch test generated strongly positive reactions against native tube material. The positive findings in the skin tests demonstrate specific hypersensitivity to the tracheal tube or its components in terms of a type I hypersensitivity. The causative component remains unclear.
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38
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Scanlon DM. Throat clearing in asthma. N Engl J Med 2003; 349:194-5; author reply 194-5. [PMID: 12853598 DOI: 10.1056/nejm200307103490220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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39
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Abstract
Respiratory tract infections are one of the most common problems prompting visits to the emergency department. Although many are the result of self-limited viral illnesses, these infections may result in substantial morbidity and, rarely, mortality. Prompt recognition and appropriate treatment can reduce morbidity and largely prevent mortality. Careful selection of antimicrobial agents is essential to maximize benefit and prevent overuse, which contributes to the emergence of antibiotic resistance.
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Affiliation(s)
- Mark A Ward
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
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40
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Abstract
CASE REPORT We report the case of a five-year-old boy with clinical features of croup and left lower lobe pneumonia. Response to inhaled adrenaline and dexamethasone was incomplete and he developed respiratory distress. Direct laryngoscopy performed in the operating room showed mild glottic and subglottic inflammation. On bronchoscopy, there was thick pus coming from the left lower lobe. He was intubated for three days and regular toilet brought back thick pus. Tracheal fluid culture grew Haemophilius influenzae. COMMENTS We suggest that he had bacterial tracheitis but that the tracheal involvement was not prominent at the time of diagnosis. CONCLUSION Laryngoscopy and bronchoscopy in specialized surroundings should be considered for each child with croup unresponsive to conventional treatment, especially in case of lower respiratory tract involvement.
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Affiliation(s)
- G de Bilderling
- Service de pédiatrie, cliniques universitaires de Mont-Godinne, université catholique de Louvain, avenue Thérasse, 5530 Yvoir, Belgique.
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41
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Abstract
We describe a patient with ulcerative colitis (UC) and the rare extraintestinal manifestation of fulminant tracheobronchitis. A 50-year-old man presented with respiratory compromise and bloody diarrhea. His evaluation showed large airway inflammation with fibrinopurulent debris and colonic inflammation and ulcerations consistent with UC. The etiology for the pulmonary pathology was thoroughly investigated and was thought to be an extraintestinal manifestation of the UC.
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Affiliation(s)
- J A Shad
- Division of Gastroenterology, Naval Medical Center, San Diego, California, USA
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42
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Abstract
Acute infections of the respiratory tract are common in pediatric patients. Respiratory disease is the leading cause of hospitalization in children less than 4 years of age and is responsible for many physicians' office and emergency department visits.(1) The severity of upper respiratory tract infection ranges from mild, self-limited disease to potentially life-threatening airway obstruction. The prepared clinician can often make a diagnosis based solely on the history and physical examination, using radiographs and laboratory examinations to aid in diagnosis when the clinical picture is unclear. At times, airway collapse is imminent, and the clinician must proceed directly to endoscopy for definitive diagnosis and airway protection. This article will discuss the pathogenesis, clinical presentation, and management of epiglottitis, croup, and bacterial tracheitis in the pediatric population.
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Affiliation(s)
- R H Stroud
- Department of Otolaryngology, The Children's Hospital, Denver, CO, USA
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43
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Chernekhovskaia NE, Iarema IV, Shishlo VK, Andreev VG, Khodos DV. [Intratracheal lymphotropic ozone therapy in erosive-ulcerous tracheitis]. Vestn Khir Im I I Grek 2001; 160:86-8. [PMID: 11258333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Under observation there were 452 patients with chronic stenosis of hollow organs of the neck having cannulas during the period from 3 months to several years. During the tracheobronchoscopic examination it was found that 35 patients had trachea ulcers, 46 patients had erosive tracheobronchitis. The ulcers were localized on the anterior wall of the thoracic part of the trachea. Their diameter was from 1 to 2.5 cm. The ulcers were accompanied by diffuse bilateral bronchitis of the II-III degree of the inflammation intensity. 2-3 ml of ozonated sodium chloride solution with the concentration of ozone in it 5 mg/l were introduced into the ulcer edges, i.e. lymphotropically, into the submucous membrane. The same solution (40-60 ml) was used for daily sanitation of the tracheobronchial tree. Complete epithelization of the ulcers and cleansing of the bronchial tree took 3-4 curative bronchoscopies.
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44
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Abstract
The long-term ventilated patient is at high risk for developing nosocomial pneumonia or tracheobronchitis. In general, the frequency of infection increases with the duration of mechanical ventilation, but the risk appears to be greatest in the first week of intubation. Although these types of infection are common and may have morbidity and mortality impact, the daily risk is less in the long-term ventilated patient than in the acutely ill intubated patient. This reduced daily risk may reflect a "survivor effect," with less healthy patients dying early in the hospital stay and not surviving long enough to undergo tracheostomy and long-term ventilation. A number of factors predispose these patients to infection, including host defense impairment and exposure to large numbers of bacteria. This exposure can occur through the airway, and proper care of respiratory therapy devices is essential to minimize the risk for infection. Most infections of the lower respiratory tract are preceded by airway colonization with EGN bacteria and, with improvement in host defenses and nutrition, infection in the face of colonization is less likely. In some patients, colonization can be eliminated. When the long-term ventilated patient does develop infection, it generally involves highly resistant gram-negative or gram-positive organisms and therapy should be prompt and appropriate. Not all such patients respond to systemic antibiotics, and the use of adjunctive aerosol therapy may have benefit for those with either tracheobronchitis or pneumonia, especially if highly resistant pathogens are present.
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Affiliation(s)
- Q A Ahmed
- Department of Critical Care Medicine, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
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45
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Porta Ribera R, Renom Llonch M, Moreno Eguilaz C, Cubells Fuentes J, Viñas Doménech L, Baraibar Castelló R. [Bacterial tracheitis due to Haemophilus influenzae]. An Esp Pediatr 2001; 54:178-80. [PMID: 11181215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We present a case of bacterial tracheitis in a 6.5 year old girl. Clinical signs and symptoms consisted of severe croup with high grade fever, which were preceded by upper respiratory tract prodrome. Initial treatment with steroids and nebulized epinephrine was unsuccessful. The patient was intubated a few hours after admission. Thick purulent secretions emerging from the trachea and the normal appearance of the epiglottis suggested the diagnosis of bacterial tracheitis, which was confirmed by isolation of Haemophilus influenzae in the culture of the tracheal secretions. The patient was administered a 14 day course of endovenous ceftriaxone and was kept on mechanical ventilation for 7 days. Fever and purulent tracheal secretions continued for the next 5 days. After 48 hours without these signs, laryngotracheobronchoscopy ruled out residual obstruction. Extubation was successfully performed. Fourteen days later physical examination showed no abnormalities and the patient was discharged. No complications were found during followup. The clinical, diagnostic and therapeutic aspects of this potentially life threatening entity that should taken into account in the differential diagnosis of severe croup are discussed.
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Affiliation(s)
- R Porta Ribera
- Servicios de PediatríaInstitut Universitari Dexeus, Barcelona, Spain
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46
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Abstract
Canine adenovirus type 1 (CAV-1) and type 2 (CAV-2) can be categorized in the laboratory by haemagglutination and neutralization tests, but they are difficult to differentiate from each other in specimens, especially when infection occurs in the digestive tract. The object of this study was to develop a simple method of detecting and differentiating them. One pair of common primers was designed and synthesized according to the sequences of the E3 and flanking regions and a polymerase chain reaction (PCR) assay was established using these two primers to amplify the virus-specific DNA fragment from clinical specimens as well as from cell cultures. After elecctrophoresis, under the same amplification conditions, 508 bp and 1030 bp PCR products were observed for CAV-1 and CAV-2, respectively. These were further shown to be adenovirus specific by dot hybridization and sequencing. As only one pair of primers was involved in the PCR procedure, it was faster and easier to perform than any of the other assays used for detecting canine adenovirus, making it applicable in the rapid confirmation of diagnosis and differentiation of the two types of canine adenoviruses.
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MESH Headings
- Adenoviridae Infections/diagnosis
- Adenoviridae Infections/veterinary
- Adenoviridae Infections/virology
- Adenoviruses, Canine/chemistry
- Adenoviruses, Canine/classification
- Adenoviruses, Canine/genetics
- Adenoviruses, Canine/isolation & purification
- Animals
- Cytopathogenic Effect, Viral
- DNA Primers/chemistry
- DNA, Viral/chemistry
- DNA, Viral/isolation & purification
- Diagnosis, Differential
- Dog Diseases/classification
- Dog Diseases/diagnosis
- Dog Diseases/virology
- Dogs
- Electrophoresis, Agar Gel/veterinary
- Hepatitis, Infectious Canine/diagnosis
- Hepatitis, Infectious Canine/virology
- Laryngitis/diagnosis
- Laryngitis/veterinary
- Laryngitis/virology
- Microscopy, Electron/veterinary
- Nucleic Acid Hybridization
- Polymerase Chain Reaction/methods
- Polymerase Chain Reaction/veterinary
- Sequence Analysis, DNA
- Tracheitis/diagnosis
- Tracheitis/veterinary
- Tracheitis/virology
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Affiliation(s)
- R L Hu
- Laboratory of Virology, Veterinary Institute, Changchun University of Agriculture and Animal Sciences, China
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47
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Koh LP, Goh YT, Linn YC, Hwang J, Tan P. Pseudomembranous tracheobronchitis caused by Aspergillus in a patient after peripheral blood stem cell transplantation. Ann Acad Med Singap 2000; 29:531-3. [PMID: 11056787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION We report a case of pseudomembranous tracheobronchitis caused by Aspergillus fumigatus 2 years after matched unrelated stem cell transplant. CLINICAL PICTURE The patient presented with dyspnoea and obstructive airway disease coinciding with the onset of chronic graft-versus-host disease (GVHD). Following treatment with higher immunosuppressive therapy for presumptive diagnosis of bronchiolitis obliterans, he subsequently developed recurrent spontaneous pneumomediastinum and progressive respiratory failure. TREATMENT AND OUTCOME Tracheobronchial biopsy and culture of bronchoalveolar lavage (BAL) fluid revealed Aspergillus tracheobronchitis. Despite mechanical ventilation and antifungal therapy, he succumbed to progressive respiratory failure. CONCLUSIONS AND CLINICAL IMPLICATIONS Aspergillus tracheobronchitis should be suspected in heavily immunosuppressed stem cell transplant recipients presenting with recurrent pneumomediastinum and progressive respiratory failure.
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Affiliation(s)
- L P Koh
- Department of Haematology, Singapore General Hospital, Singapore
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48
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Oymar K. [Bacterial tracheitis in children]. Tidsskr Nor Laegeforen 2000; 120:1417-9. [PMID: 10851938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Bacterial tracheitis is an uncommon, but serious cause of acute respiratory distress in children. The incidence is not known. MATERIAL AND METHODS The medical records of four children with bacterial tracheitis treated in our hospital are presented, and the literature reviewed to describe symptoms, diagnosis and treatment. A questionnaire was sent to all pediatric departments in Norway to assess the incidence of bacterial tracheitis and epiglotitis during the 1994-98 period. RESULTS The yearly incidence of bacterial tracheitis was estimated to 4 per 1,000,000 for children aged 0-15, and 8 per 1,000,000 for children aged 0-5. The incidence of epiglotitis was 1.0 per 1,000,000 for children 0-15 years. INTERPRETATION Bacterial tracheitis is now more common than epiglotitis, and the diagnosis has to be considered in children presenting with acute illness and upper airway respiratory distress. The disease is characterised by marked purulent exudate and formation of pseudomembranes in the trachea. Staphylococcus aureus and Haemophilus influenzae type b are the predominant causes of bacterial tracheitis. Most patients require endotracheal intubation, with the highest frequency in the youngest children. Reported complications include cardiopulmonary arrest, toxic shock syndrome and pulmonary oedema. Appropriate treatment with antibiotics is essential.
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Affiliation(s)
- K Oymar
- Barneavdelingen Sentralsjukehuset i Rogaland, Stavanger
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49
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Steiger RR, Williams MA. Granulomatous tracheitis caused by Conidiobolus coronatus in a horse. J Vet Intern Med 2000; 14:311-4. [PMID: 10830546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- R R Steiger
- Department of Large Animal Surgery and Medicine, College of Veterinary Medicine, Auburn University, AL 36849-5522, USA.
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50
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Abstract
BACKGROUND AND OBJECTIVE Acute epiglottitis, bacterial tracheitis, and severe viral laryngotracheobronchitis continue to cause life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in treatment, to clarify the role of airway endoscopy, and to identify current reasons for fatalities in these diseases. MATERIALS AND PATIENTS During the observation period from 1980 to 1996, we identified 61 patients treated in the pediatric intensive care unit of the University Hospital of Cologne for severe inflammatory airway obstruction. RESULTS Critical points in the appropriate airway management were (1) the confirmation of the admission diagnosis, (2) whether an artificial airway or rigid tracheobronchoscopy was required; and (3) appropriate timing of extubation. Since 1989 airway evaluation with flexible or small, rigid endoscopes was used to confirm the diagnosis and to determine the appropriate management. Endoscopic findings were extremely helpful to decide not to intubate and to monitor in the pediatric intensive care unit first. Three patients with acute epiglottitis died after out-of-hospital cardiorespiratory arrest. CONCLUSION Endoscopy should be a part of every established treatment protocol of childhood stridor. The most decisive factor to decrease mortality seems to be timely presentation to a referral center.
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Affiliation(s)
- M Damm
- Department of Oto-Rhino-Laryngology and Children's Hospital, University of Cologne, Germany
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