Bacterial tracheitis: an unusual pathogen.
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[Polyvaccin and Subtivaccin in the treatment of bronchia asthma and recurrent pharyngitis, tonsillitis, tracheitis and bronchitis in children].
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Asthma↗
Severe upper airway obstruction in the tropics requiring intensive care.
BACKGROUND: The clinical profile of severe upper airway obstruction, a challenging acute pediatric emergency, has not been extensively documented in the developing nations of the tropics. METHODS: The diagnostic categories, severity of illness and outcome from 63 episodes of severe upper airway obstruction in 56 children admitted to the Pediatric Intensive Care Unit between January 1994 and December 1999 were reviewed. Outcome variables studied included requirement for ventilation, mortality and complications. Severity of illness was determined with the Pediatric Risk of Mortality (PRISM) II score. RESULTS: Viral croup (29%) was the most common diagnosis, followed by mediastinal malignancy (13%), bacterial tracheitis (11%) and Pierre Robin syndrome (11%). There were no admissions for acute epiglottitis. Thirty episodes (48%) required ventilation for a median duration of 4.0 days. Bacterial tracheitis (100%) and subglottic stenosis (100%) were the most likely diagnoses requiring ventilation. Difficulty in intubation was encountered in 13 episodes (43%) involving, in particular, patients with bacterial tracheitis (83%; P = 0.006). Only two patients required a tracheostomy. The overall mortality was 11%. The PRISM score for all categories was generally low (mean 10.3 +/- 1.0; median 9.0). Non-survivors had a significantly higher PRISM II score than survivors (27.4 +/- 9.7 vs 8.1 +/- 4.9, respectively; P = 0.002) and were more likely to include children with bacterial tracheitis and mediastinal malignancy. CONCLUSIONS: There is marked heterogeneity in the causes of upper airway obstruction in the tropics with viral croup remaining the most common. A significant proportion required ventilation, but outcome is generally favorable, except in those with bacterial tracheitis and mediastinal malignancy.
Airway Obstruction↗
Respiratory coccidiosis (Cryptosporidium baileyi) among northern Georgia broilers in one company.
Cryptosporidium baileyi causes respiratory disease in chickens. The purposes of this prospective study were to determine the incidence of C. baileyi tracheitis among broilers in a commercial setting, and the relationship between C. baileyi tracheitis and production performance parameters. All samples came from 56 farms that grow broilers for one company in northern Georgia. Tracheas were collected and examined with a light microscope and cultured for viruses and bacteria. Overall, 23 of 56 (41%) broiler flocks had C. baileyi tracheitis. Parasitism rates among C. baileyi-infected flocks ranged from a low of 10% to a high of 60%. Cryptosporidium baileyi tracheitis was very highly correlated (rho = 0.81, n = 56, P < 0.00001) to severity of tracheitis, negatively correlated (rho = -0.27, n = 56, P < 0.04) with average body weight, and correlated with airsacculitis (rho = 0.30, n = 56, P < 0.03) and condemnations (rho = 0.27, n = 56, P < 0.05). The present study indicates that C. baileyi infection rates are high, and the role that this parasite plays in the pathogenesis of respiratory disease and production losses could be unexpectedly large.
Animal Husbandry↗
MYXOVIRUSES ASSOCIATED WITH ACUTE LARYNGOTRACHEOBRONCHITIS IN TORONTO, 1962-63.
Between November 1962 and March 1963, myxoviruses were isolated from 95 of 224 children (40.5%), most of whom were aged less than three years, who were admitted to The Hospital for Sick Children, Toronto, with acute laryngotracheobronchitis (tracheitis or croup). Viral isolates included 87 strains of Parainfluenza-1, five of Parainfluenza-3, and three of Influenza A2. An epidemic of Influenza A2 afflicted Toronto during March 1963, at which time this virus was isolated from tracheitis patients.Myxoviruses were isolated from nasopharyngeal secretions of 285 of 794 tracheitis patients between November 1960 and March 1963. Parainfluenza-1 virus was the dominant serotype, being found in 241 (30.0%) of subjects. Three peaks of Parainfluenza-1 virus isolations were observed in December 1960, March 1962 and November 1962, and this serotype has been isolated during all months except June and July. Although most of the 28 Parainfluenza-3 virus infections occurred between November and February, this strain has also been isolated during summer. Strains of Influenza A2 and Influenza B viruses have been isolated from tracheitis patients during epidemics of influenza in Toronto due to these agents.
Antibodies↗
[The value of endoscopy in recurrent acute laryngotracheitis in children. Apropos of 406 cases].
Acute laryngo-tracheitis in infants represents a common cause of respiratory distress with stridor accompanied with hospital admission. The prognosis is usually favorable in light of the available medical and environmental management. We performed a retrospective analysis of 1739 case reports from 1974 to 1989 with special attention being paid to infants admitted three times or more for recurrent acute laryngo-tracheitis. An ENT consultation was requested in 406 infants which resulted with an endoscopy being performed. Narrowing of the airway was noted in 75% of cases. Dynamics of fluids explains why a silent lesion becomes symptomatic as soon as an inflammatory process is also present. As there are pathologies which are life-threatening, we advocate routine endoscopy as a precautionary method of investigation, followed by close reassessments, in all cases of recurrent acute laryngo-tracheitis with dyspnea. Preferably, this procedure should be performed between dyspneic episodes.
Acute Disease↗
Bacterial croup and toxic shock syndrome.
An 8-year-old boy with bacterial tracheitis, treated by endotracheal intubation, humidification, airway toilet and antibiotics, experienced a toxic shock syndrome on the day after his admission. The course was favourable. Staphylococcus aureus was isolated from tracheal secretions. Bacterial tracheitis is an infrequent cause of non-menstrual toxic shock syndrome. The diagnosis of bacterial tracheitis should be suspected in a child with toxicity and croup who is not responding to the usual therapy. Endoscopy should be performed allowing for removal of the secretions. The maintenance of a clear airway is the main purpose of the treatment.
Child↗
Croup syndrome in children: five-year experience.
To investigate the etiology and clinical features of croup syndrome, clinical records of hospitalized children with a diagnosis of croup syndrome were reviewed from April 1990 to January 1996. There was a total of 132 children, aged between three months and seven years with a mean age of 21.3 +/- 16.8 months. A diagnosis of laryngotracheobronchitis was made in 123 (93.2 percent) children. Twenty-three pathogens were identified in twenty-two of them, including seven parainfluenza viruses, five respiratory syncytial viruses, four influenza A viruses, four Mycoplasma pneumoniae, and three adenoviruses. Bacterial tracheitis was confirmed by bronchoscopic examination in seven cases (5.3 percent). Cultures of the respiratory secretions yielded viridans streptococci in six and Staphylococcus aureus in one child. Two children (1.5 percent) had spasmodic croup. No case with epiglottitis was noted in the present study. A fever lasting for more than three days was noted in five (71 percent) children with bacterial tracheitis and thirty-five (28 percent) children with laryngotracheobronchitis (p = 0.048). Among children with laryngotracheobronchitis, an associated diagnosis of pneumonia, acute otitis media, or paranasal sinusitis was more frequently observed in those with fever > 3 days (40 percent) than those with a shorter duration of fever (17 percent, p = 0.013). In conclusion, a child with a longer duration of fever and more severe manifestations of airway obstruction probably has a bacterial cause of croup syndrome or a bacterial complication. Bacterial tracheitis is more common than epiglottitis in Taiwan.
Child↗
SEROLOGIC, PATHOLOGIC, AND SYMPTOMATIC ASPECTS OF MYCOPLASMOSIS OF TURKEYS.
Adult male turkeys were exposed to Mycoplasma gallisepticum isolate 1010 by either intratracheal inoculation, intrasinus inoculation, intranasal inoculation or by contact with inoculated turkeys. The symptomatic, serologic, and pathologic responses to the different types of exposure were compared. Tracheitis occurred only in birds exposed intratracheally or by contact, and sinusitis occurred only in birds exposed via the sinuses. Antibody titers, determined by hemagglutination-inhibition and tube agglutination tests, were initially higher in turkeys exposed by intratracheal and intrasinus inoculation than in those exposed by other means. There were no appreciable differences among the four groups in incidence or severity of air sac lesions. In addition, the effects of intrasinus exposure to isolate 1010 were compared with those produced by similar exposure to a different isolate, M. gallisepticum isolate 1150. Isolate 1010 caused a slightly higher incidence of sinusitis, but a much lower incidence of tracheitis than isolate 1150. Air sac lesions did not differ in incidence or severity. The differences observed indicate differences in tissue predilection of the isolates.
Agglutination↗
Mortality of Rheas caused by a Synchamus trachea infection.
Over the last 3 years, chronic respiratory distress occurred occasionally in young birds on a farm with about one hundred Rheas americana. The sick Rheas died after 1 to 2 months. Post-mortem examination of a 7-week-old Rhea showed severe tracheitis. This tracheitis was caused by Synchamus trachea worms, which were present in large numbers. Therapy with fenbendazole cured the respiratory distress of the other Rheas within a few days.
Animals↗
Performance of gross lesions at postmortem for the detection of outbreaks during the avian influenza A virus (H7N7) epidemic in The Netherlands in 2003.
A total of 123 submissions (on average, five birds per submission) from poultry flocks with a suspicion of an infection with highly pathogenic avian influenza virus were investigated at postmortem during the 2003 epidemic in The Netherlands. A total of 86 of these submissions were from infected flocks (positive submissions), and 37 submissions were from non-infected flocks (negative submissions). Peritonitis was the most frequently (62%) recorded pathological finding in positive submissions, followed by tracheitis (43%), oedema of the neck and/or wattles (12%) and (petechial) haemorrhages in the proventriculus (4%). A total of 17% of the positive submissions consisted of birds without any macroscopic lesion. The pathological lesions observed in our study do not fully comply with descriptions in literature, especially the lack of haemorrhagic changes in tissues and low prevalence of oedema of the neck, comb and wattles. It is recommended that if peritonitis, or tracheitis, or oedema of the neck and/or wattles or (petechial) haemorrhages in the proventriculus is observed at postmortem examination, especially if accompanied by an anamnesis describing acute and high mortality in a flock, this should consistently result in follow-up action to exclude highly pathogenic avian influenza in the differential diagnosis as cause of the disease problems by testing tissue samples with an avian influenza-specific laboratory test at the avian influenza reference laboratory.
Animals↗
Mitogenicity and pathogenicity of Mycoplasma pulmonis in rats. I. Atypical interstitial pneumonia induced by mitogenic myeoplasmal membranes.
Mitogenic preparations of nonviable lysed cells and purified membranes of Mycoplasma pulmonis induced interstitial pneumonia and tracheitis after intranasal administration to pathogen-free rats. The pneumonia, characterized by peribronchial, perivascular, and alveolar wall infiltration by lymphocytes, was indistinguishable from that produced by viable M. pulmonis. Both pathologic and mitogenic effects were significanlty reduced by prior treatment of membranes with heat or proteolytic enzyme. Intranasal administration of the thymus-derived-cell mitogen, concanavalin A, produced interstitial pneumonia but not tracheitis. These results indicate a correlation of mitogenicity and pathogenicity and suggest that activation of thymus-derived lymphocytes is the major cause of the pneumonia resulting from infections with M. pulmonis.
Animals↗
Measles: an epidemic of upper airway obstruction.
Between October 1989 and August 1990, Dallas County experienced an 11-month epidemic of measles. Of 995 cases of pediatric measles diagnosed in the outpatient department of Children's Medical Center, 108 patients were admitted and 34 of these demonstrated significant upper airway obstruction at the time of admission. Airway problems ranged from mild inspiratory stridor with nasal flaring to frank obstruction and arrest in the emergency room, requiring intubation. Eight of the 34 airway patients were eventually diagnosed with bacterial tracheitis on the basis of endoscopic findings and culture results. The remaining patients had pictures more consistent with viral laryngotracheitis, but all patients were treated with broad-spectrum antibiotics to prevent possible progression to bacterial tracheitis. A total of nine patients overall required intubation for airway obstruction and all were successfully extubated. Large outbreaks of measles are becoming common again in populations of urban poor--largely unvaccinated children. The disease in these populations tends to occur at a younger age and may be more aggressive with more associated complications. Physicians must keep in mind the possibility of upper airway obstruction in a significant proportion of these patients. Early diagnosis on the basis of clinical signs and symptoms, endoscopy, and radiographs is the key to timely appropriate management.
Adolescent↗
Respiratory failure complicating rubeola.
We reviewed the charts of 19 patients with the diagnosis of measles who were admitted to the pediatric intensive care unit for respiratory failure requiring intubation and mechanical ventilation. Patients studied were admitted during the period June 1989 to June 1990. The mean age was 19 months (range, 3 to 51 months). The cause for respiratory failure fell into two groups: 47 percent developed pneumonitis and refractory hypoxemia. Patients with pneumonitis and hypoxemic respiratory failure had a 56 percent mortality. An oxygenation index of greater than 40 for 4 h separated survivors from nonsurvivors (oxygenation index = [mean airway pressure x FIo2/PaO2 x 100]). Patients with tracheitis alone all survived. In these patients the organism primarily responsible was Staphylococcus aureus (70 percent). Two of the seven patients with S aureus tracheitis had signs and symptoms of toxic shock syndrome and we subsequently demonstrated toxic shock syndrome toxin 1 in both patients.
Child, Preschool↗
Histopathology of a rhinotracheitis of turkey poults associated with adenoviruses.
Tissues from turkey poults with adenovirus-associated respiratory disease were examined for microscopic lesions. Histopathologic changes observed in tissue from poults submitted with clinical signs of severe respiratory disease ranged from an acute mucoid rhinotracheitis through a fibrinonecrotic tracheitis to a chronic polypoid tracheitis with squamous metaplasia of the tracheal epithelium. Clinically normal poults housed with poults that subsequently developed clinical signs of the disease rarely had basophilic intranuclear inclusions within the epithelial cells of nasal turbinates.
Adenoviridae Infections↗
Involuntary smoking and incidence of respiratory illness during the first year of life.
A prospective study of 1,144 infants and their families was performed. Smoking and family histories were evaluated with respect to the incidence of lower respiratory disease during the first year of life. It was found that (1) tracheitis and bronchitis occurred significantly more frequently in infants exposed to cigarette smoke in the home, (2) maternal smoking imposed greater risks upon the infant than paternal smoking, (3) occurrence of neither tracheitis nor bronchitis showed a consistent relationship to the number of cigarettes smoked, (4) a family history that was positive for respiratory illness (chronic cough or bronchitis) significantly influenced the incidence of bronchitis, (5) too few cases of laryngitis and pneumonia were seen to warrant any opinions regarding the adverse influence of either smoking or a family history that was positive for respiratory illness, and (6) occurrence of bronchiolitis was not affected by the presence of a smoker nor influenced by a family history that was positive for respiratory illness. It is concluded that passive smoking is dangerous to the health of infants and that infants born to families with a history that is positive for respiratory illness (chronic cough or bronchitis) are at risk of developing bronchitis.
Adult↗
Pasteurella anatipestifer-like bacteria associated with respiratory disease in pigeons.
Two cases of respiratory disease in pigeons are described. The first case involved pneumonia and tracheitis, and the second case involved tracheitis. In both cases, unusual gram-negative, non-fermenting, short rod-shaped bacteria were recovered along with other microorganisms. The bacteria produced small, glistening, gray colonies on blood agar, did not grow on MacConkey agar, were unreactive on several biochemical tests, and resembled Pasteurella anatipestifer. Neither pigeon isolate was distinguished from P. anatipestifer by biochemical tests. However, there were morphologic and growth differences between the pigeon isolates and P. anatipestifer. Furthermore, unlike P. anatipestifer, both pigeon isolates were sensitive to aminoglycoside antibiotics and to polymyxin B. Finally, neither isolate was agglutinated by antisera to 15 serotypes of P. anatipestifer. Diagnosticians, especially those who seldom encounter P. anatipestifer, might have difficulty distinguishing the pigeon isolates from P. anatipestifer because of their close resemblance.
Animals↗