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PubMedDate not supplied

The need for intubation in serious upper respiratory tract infection in pediatric patients (a retrospective study).

Serious bacterial infections occurred in ten children (1.4%) of 710 patients with croup admitted to the Soroka Medical Center during the years 1983-1989. Sixty-four patients (9% of all croup patients) were admitted to the pediatric intensive care unit (PICU), and 13 of them (20%) required intubation. Bacterial infections were noted in nine of the 13 intubated patients, in none of the other 51 PICU patients who did not require intubation and in one of the 646 patients (0.2%) who were not admitted to the PICU (p less than 0.0001). There was no difference in age, ethnic origin, or body temperature on arrival between the two PICU groups. Causative microorganisms were isolated from blood samples (three cases) and tracheal pus (eight cases). All intubated PICU patients were seriously ill: eight had bacterial tracheitis and one supraglottitis. Patients with bacterial tracheitis required frequent suctioning of the trachea for copious purulent secretions. The single patient with bacterial infection who was not admitted to the PICU had transient bacteremia. We conclude that the need for intubation in croup patients was an indicator for the presence of a serious bacterial infection.

Anti-Bacterial Agents↗
PubMed1986

Inhalation toxicity study on rats exposed to titanium tetrachloride atmospheric hydrolysis products for two years.

Rats were exposed to TiCl4 hydrolysis products by inhalation exposure at aerosol concentrations of 0, 0.1, 1.0, and 10 mg/m3 for 6 hr/day, 5 days/week for 2 years. There were no abnormal clinical signs, body weight changes, or excess mortality in any exposed groups. No pathological changes other than a mild rhinitis were observed at 0.1 mg/m3. At 1.0 mg/m3, the incidence of mild rhinitis and tracheitis was increased. The lungs showed a minute dust-laden macrophage (dust cell) reaction with slight Type II pneumocyte hyperplasia in alveoli adjacent to the alveolar ducts. The pulmonary response at the 1.0 mg/m3 satisfied the biological criteria for a nuisance dust. At 10 mg/m3, extrapulmonary particle deposition occurred in the tracheobronchial lymph nodes, liver, and spleen without any tissue response. An increased incidence of rhinitis, tracheitis, and dust cell response with Type II pneumocyte hyperplasia, alveolar bronchiolarization, foamy dust cell accumulation, alveolar proteinosis, cholesterol granuloma, and focal pleurisy was also observed. The pulmonary lesions developed in the alveolar duct region where dust cells had accumulated and had provoked a chronic tissue response. In addition, a few well-differentiated, cystic keratinizing squamous carcinomas were developed from alveoli showing bronchiolarization with squamous metaplasia in the alveolar duct region. No tumor metastasis was found in other organs. The lung tumors were a unique type of experimentally induced tumor and have not been seen usually in man or animals. Therefore, the relevance to man of this type of lung tumor is highly questionable.

Animals↗
PubMed1999

Chronic toxicity and carcinogenicity studies of ethylenediamine dihydrochloride by dietary incorporation in Fischer 344 rats.

Ethylenediamine dihydrochloride (EDA.2HCl) was incorporated into the diet and fed to Fischer 344 rats for 2 years at target doses of 0, 0.02, 0.10 or 0.35 g/kg/day (equivalent to 0.009, 0.045 and 0.158 g free EDA/kg/day). Two separate untreated control groups were used. Interim sacrifices were at 6, 12 and 18 months and the terminal sacrifice was at 24 months. Under the conditions of this study, EDA.2HCl was not carcinogenic in the Fischer 344 rat. Most toxic responses were observed at the 12-month sacrifice and thereafter. Reductions in mean body weight gain were observed in high dose group male rats throughout most of the study and in the high dose group of female rats after approximately 18 months. Conversely, there was a slight increase in the mean body weight gain for the medium level female rats from about day 21 until 21 months that was of equivocal biological significance. Increased mortality was observed in the high dose group of both sexes and the mid dose group of female rats. The cause of the decreased survival was unclear, but may have been related to the enhancement of background degenerative lesions such as chronic nephropathy. Throughout the study, male rats from the high dose group had decreased erythrocyte counts, haemoglobin concentration and haematocrit. The cause and biological significance of the haematological changes were unknown. Increased water consumption was observed in the high dose group of both sexes during the latter half of the study. Increased urine volume with concurrent decreased urine specific gravity was generally observed in the high dose group of both sexes in the last half of the study and suggested a possible alteration in kidney function. Altered urine volume and specific gravity persisted to termination in female rats only. Slight increases in absolute and relative kidney weights were also observed in the high dose group of female rats during the latter half of the study. Hepatocellular pleomorphism was observed in the high dose group of both sexes, especially the female rats, and may have contributed to increased mean liver weights observed primarily in female rats from the high dose group. Hepatocellular pleomorphism was first observed in female rats at 12 months but was not observed in male rats until the final sacrifice. Rhinitis and tracheitis were observed with greater frequency in the high dose group of male rats at 12, 18 and 24 months and in high dose group female rats at 18 months. At 24 months, rhinitis, but not tracheitis, persisted at a significantly greater frequency in high dose group female rats. The apparent no-observable-effect level (NOEL) of this study was at the lowest dose level, 0.02 g/kg/day (equivalent to 9 mg EDA/kg/day).

Animals↗
PubMed2001

Purulence and gram-negative bacilli in tracheal aspirates of mechanically ventilated very low birth weight infants.

OBJECTIVE: Tracheal aspirates (TAs) from mechanically ventilated very low birth weight (VLBW) infants are frequently obtained during the evaluation of suspected sepsis, tracheitis, or ventilator-associated pneumonia (VAP). Purulence and bacteria in Gram stain of bronchopulmonary secretions are considered signs of respiratory infection, and medical decisions are made on the assumption that they are predictors of positive bacterial tracheal cultures (TCs). The purpose of this retrospective investigation was to establish the relationship of purulence and bacteria in TA from ventilated VLBW infants with positive TC and to identify its clinical significance. STUDY DESIGN: One hundred and seventy consecutively born VLBW infants (1996 to 1998) who remained on mechanical ventilation longer than 1 week were studied. Demographic, laboratory, and clinical data were obtained from hospital medical records. Purulence, defined by the number of polymorphonuclear leukocytes (PMNs) per low power field (LPF), was reported as light (<25 PMNs/LPF) or moderate/heavy (>or=25 PMNs/LPF) for every TA. RESULTS: Purulence was absent in 469 of 646 (72%) TA taken from 170 infants. Light purulence was present in 17% and moderate/heavy purulence in 11%. TCs were positive in 58% of non-purulent, 94% of light, and 100% of moderate/heavy purulent TA. Bacteria on Gram stain were present in 12% of non-purulent, 70% of light purulent, and 83% of moderate/heavy purulent TA. Moderate/heavy purulence in TA was predictive of a positive TC with Gram-negative bacilli (GNB) with 70% sensitivity, 100% specificity, 100% positive predictive value, and 67% negative predictive value. Purulence in TA, as well as GNB airway colonization, became more frequent as mechanical ventilation progressed and was not associated with a particular GNB species. There were 79 infants who never had purulent TA and 91 who, at some time during the hospitalization, did. At the time of first purulent TA, 65 (71%) of 91 infants were asymptomatic. Twenty-six infants (29%) had clinical deterioration for which they underwent sepsis work-up. Three had blood stream infection, 5 VAP, 5 tracheitis, and 13 respiratory complications of non-infectious etiology. Four of five VAP infants died; all others survived. CONCLUSION: In VLBW infants, purulence in TA is associated with prolonged endotracheal intubation and is temporally related to GNB airway colonization. At the time of the first purulent TA, the majority of mechanically ventilated VLBW infants are asymptomatic. Only a few symptomatic VLBW infants had nosocomial respiratory infection. Understanding the clinical significance of purulence and GNB in TA from this unique patient population is important for management and prognosis, and it may decrease concern for infection and the associated use of antibiotics.

Body Fluids↗
PubMed1990

Experimental respiratory infection of goats with caprine herpesvirus and Pasteurella haemolytica.

Groups of six male goats were inoculated intratracheally and intranasally with either caprine herpesvirus followed 6 days later by Pasteurella haemolytica, canine herpesvirus alone or P. haemolytica alone. Pneumonic lesions were observed in five of the six goats inoculated with caprine herpesvirus followed by P. haemolytica and in three of the six goats inoculated with P. haemolytica alone, but were not observed in goats inoculated with caprine herpesvirus alone or in non-infected controls. Pasteurella haemolytica was isolated from seven of eight lungs with pneumonia, but only from one of sixteen lungs without pneumonia. The lesions ranged from fatal acute exudative necrotising pneumonia to predominantly proliferative pneumonia. Half of the caprine herpesvirus-inoculated goats developed a clinical catarrhal rhinitis five days post-inoculation and the only virus-specific histopathological lesion was a mild tracheitis. Canine herpesvirus was recovered from the nasal swabs of all caprine herpesvirus- inoculated goats developed a clinical catarrhal rhinitis five days post-inoculation and the only virus-specific histopathological lesion was a mild tracheitis. Canine herpesvirus was recovered from the nasal swabs of all canine herpesvirus-inoculated goats and from the lungs of three goats inoculated with caprine herpesvirus alone. The experimental inoculations demonstrated that P. haemolytica alone can produce pneumonia in goats. In addition, the study showed that caprine herpesvirus readily proliferates in the upper respiratory tract and lungs of goats but the role of caprine herpesvirus in the aetiology of pneumonia remains uncertain.

Journal Article↗
PubMed1983

Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study.

The purpose of this study was to assess the incidence, evolution and long-term effects of laryngotracheal lesions due to endotracheal intubation and to evaluate the import of factors in the genesis of laryngotracheal injury. Over a 12-month period, we performed fiberoptic bronchoscopy (FBS) in 19 critically ill patients with endotracheal intubation. Early laryngeal lesions, mainly true vocal cord granulomas and ulceration, appeared in 12 (63%) patients and were resolved by the 3rd month in all but 3 patients. In 6 (31%) patients, early tracheal lesions appeared in the form of ring-shaped tracheitis at the cuff level and granulomas at the tube-tip level; in 2 (10%) patients, an established tracheal stenosis developed and early detected ring-shaped tracheitis preceded circumferential fibrous stenosis. Severe respiratory failure, high cuff pressure, and secretion infection showed a statistical correlation to tracheal injury.

Adult↗
PubMed1985

Exacerbation of murine respiratory mycoplasmosis in gnotobiotic F344/N rats by Sendai virus infection.

Six- to eight-week-old gnotobiotic F344/N rats were inoculated intranasally with 10(5.0) colony-forming units of Mycoplasma pulmonis or were sham inoculated, then one week later were given 10(0.2) 50% tissue culture infective doses of Sendai virus or sterile medium. Groups of rats were killed immediately after virus inoculation and three, five, ten, and 20 days later. Lesions in nasal passages, middle ears, larynxes, tracheas, and lungs from half of the rats in each group were subjectively scored. Organs from the other rats were quantitatively cultured for M. pulmonis and for Sendai virus. Rats given Sendai virus alone had mild, patchy, necrotizing rhinitis, laryngitis, tracheitis, and bronchitis, but not bronchiolitis or interstitial pneumonia. M. pulmonis alone induced mild lesions of murine respiratory mycoplasmosis including mild to moderate suppurative rhinitis, otitis media, laryngitis, and tracheitis with submucosal lymphoid accumulation and epithelial hyperplasia, but not lung lesions. Rats given M. pulmonis and Sendai virus had severe lesions characteristic of advanced mycoplasmal disease throughout the respiratory tract, including suppurative bronchitis with extensive lymphoid accumulations and epithelial hyperplasia; some rats also had suppurative pneumonia and bronchiectasis. Larger numbers of M. pulmonis colony-forming units were in rats given Sendai virus, but there was no statistically significant difference in Sendai virus infectious units between rats also given M. pulmonis and those given virus only.

Animals↗
PubMed2001

Weaning children from mechanical ventilation: a prospective randomized trial of protocol-directed versus physician-directed weaning.

OBJECTIVE: Compare outcomes between physician-directed and protocol-directed weaning from mechanical ventilation in pediatric patients. DESIGN: Prospective-randomized. SETTING: Pediatric and cardiac intensive care units in a 307-bed tertiary referral hospital for children. INTERVENTIONS: The control group (physician-directed) was weaned according to individual physician order for reduction in minute ventilation, positive end-expiratory pressure, and ordered oxygen saturation parameters for reduction in fraction of inspired oxygen (F(IO)(2)). The study group (protocol-directed) was weaned according to a predetermined algorithm developed for the purpose of this investigation. METHODS: The study enrolled 223 patients (116 physician-directed, 107 protocol-directed). All patients were monitored for hemodynamics, ventilator parameters, arterial blood gas values when available, oxygen saturation, weaning time, pre-weaning time, extubation time, and time on F(IO)(2) > or = 0.40. We also monitored the incidence of reintubation, subglottic stenosis, tracheitis, and pneumonia. The protocol-directed group had additional measurements of actual versus predicted minute volume, comparisons of respiratory rate (actual versus predicted for age), and presence of spontaneous breathing effort for 10 consecutive minutes. Data analysis was done according to intent to treat. RESULTS: There was no significant difference in 12-hour and 24-hour pediatric risk of mortality (PRISM III) scores between groups. The protocol-directed group overall had shorter total ventilation time, weaning time, pre-weaning time, time to extubation, and time on F(IO)(2) >0.40, although after stratification for respiratory diagnosis, only the difference in weaning time remained significant. There was no difference in the incidence of reintubation, new-onset tracheitis, subglottic stenosis, or pneumonia. CONCLUSIONS: Protocol-directed weaning resulted in a shorter weaning time than physician-directed weaning in these pediatric patients.

Algorithms↗
PubMedDate not supplied

Experimental reproduction of Mycoplasma gallisepticum disease in chukar partridges (Alectoris graeca).

An outbreak of conjunctivitis and severe respiratory disease occurred in an integrated chukar partridge (Alectoris graeca) operation that involved about 8000 birds. The main clinical features were conjunctivitis and sinusitis and frequent mouth breathing, but almost no gasping or coughing. In 1000 breeders, egg production declined from 73% to 20%. Morbidity reached 100%, and losses from mortality and culling approached 60%. At necropsy, a conjunctivitis (often bilateral) and extensive caseated sinusitis were common. There was an occasional slight mucoid tracheitis, but no significant air sac lesions were noted. Mycoplasma gallisepticum, designated strain GM1125, was isolated and identified. Exposure of susceptible chukars to GM1125 reproduced the field disease. GM1125 was reisolated from the conjunctiva of all exposed birds 12 days postinfection, but infrequently from there or the respiratory system 36 days postexposure, even though clinical disease was still present. The experimental disease was confined to the conjunctiva and the upper respiratory tract. An occasional mucoid tracheitis was noted, but generally, the lungs and air sacs were not involved. Infection was followed by an appreciable serological response to M. gallisepticum.

Animals↗
PubMed1989

Branhamella catarrhalis bronchopulmonary isolates in PICU patients.

Branhamella catarrhalis is commonly considered a respiratory commensal but has recently been implicated as a pathogen, particularly in adults. Over a 28 month period, B. catarrhalis was isolated from bronchopulmonary secretions of 14 PICU patients with acute respiratory infections. Twelve patients had pneumonia and two had tracheitis. The mean age was 3.5 years. Seven patients had chronic cardiopulmonary disease including two who were immunosuppressed. Three had an acute underlying condition and four had no complicating medical problem. Polymorphs and Gram-negative diplococci on Gram stain were found in respiratory secretions of all patients. Twelve of 14 isolates produced beta-lactamase, and six patients had a second potentially pathogenic bronchopulmonary isolate. All patients were treated for B. catarrhalis infection and none died. When isolated in pure culture from bronchopulmonary secretions in symptomatic patients, B. catarrhalis should be considered a pathogen. When isolated in mixed culture, its pathogenic role is uncertain. We conclude that B. catarrhalis can be a bronchopulmonary pathogen in critically ill children with otherwise normal cardiopulmonary function as well as in those with chronic cardiopulmonary dysfunction. When administering antibiotics the high frequency of beta-lactamase-producing strains must be taken into consideration.

Adolescent↗
PubMed1985

Pulmonary response of rats exposed to titanium dioxide (TiO2) by inhalation for two years.

Rats were exposed to TiO2 by inhalation exposure to concentrations of 0, 10, 50, and 250 mg/m3 for 6 hr/day, 5 days/week for 2 years. There were no abnormal clinical signs, body weight changes, or excess mortality in any exposed group. Exposed groups showed slight increases in the incidence of pneumonia, tracheitis, and rhinitis with squamous metaplasia in the anterior nasal cavity. The pulmonary response at 10 mg/m3 satisfied the biological criteria for a "nuisance dust." The lung reaction was characterized by dust-laden macrophage (dust cell) infiltration in the alveolar ducts and adjoining alveoli with hyperplasia of Type II pneumocytes. Rats at 50 and 250 mg/m3 exposure concentrations revealed a dose-dependent dust cell accumulation, a foamy macrophage response, Type II pneumocyte hyperplasia, alveolar proteinosis, alveolar bronchiolarization, cholesterol granulomas, focal pleurisy, and dust deposition in the tracheobronchial lymph nodes. Minute collagenized fibrosis occurred in the alveolar walls enclosing large dust cell aggregates. The pulmonary lesions with massive dust accumulation appeared to be the result of an overwhelmed lung clearance mechanism at 250 mg/m3 exposure. Bronchioloalveolar adenomas and cystic keratinizing squamous cell carcinomas occurred at 250 mg/m3 exposure, while no compound-related lung tumors were found in rats exposed to either 10 or 50 mg/m3. In addition to excessive dust loading in the lungs of rats exposed chronically at 250 mg/m3, the lung tumors were different from common human lung cancers in terms of tumor type, anatomic location, tumorigenesis, and were devoid of tumor metastasis. Therefore, the biological relevance of these lung tumors and other pulmonary lesions for man is negligible.

Animals↗
PubMed2004

Sudden cardiac death in a 5-year-old girl associated with parvovirus B19 infection.

We report on a 5-year-old girl who suddenly collapsed and died while dancing at a family party. Histological examination of the heart including the cardiac conduction system revealed lymphocytic infiltrations of the sinu-atrial node and perivascular infiltration in the atrio-ventricular region. Additionally, foci of mononuclear infiltrates were observed in the myocardium. Consequently, myocarditis was diagnosed as cause of death. The child also had lymphocytic conjunctivis, parotitis and tracheitis. Evaluation of infections by means of nested polymerase chain reaction revealed parvovirus B19 DNA (PVB19) in tissue samples of the trachea.

Child, Preschool↗
PubMed1996

Respiratory and digestive lesions caused by Salmonella arizonae in two snakes.

Cases of diphtheritic necrotizing gastritis in a Rosy Boa (Lichanura trivirgata) and of necrotizing tracheitis in a double-headed Kingsnake (Lampropeltis hondurensis), both associated with Salmonella arizonae, are described. An immunoperoxidase technique indicated that S. arizonae played a role in the causation of the lesions. In addition, the study showed the value of the technique for the detection of S. arizonae in the tissues of infected snakes.

Animals↗
PubMed1999

Isolation and experimental transmission of a reovirus pathogenic in ratsnakes (Elaphe species).

A reovirus was isolated from juvenile Moellendorff's ratsnakes (Elaphe moellendorffi) and beauty snakes (Elaphe taenuris) that died soon after importation into the USA. Viper heart (VH2) cells inoculated with tissue homogenates showed cytopathic effects consisting of large syncytia formation followed by cell detachment from the monolayer. Tissue culture supernatants failed to hemagglutinate guinea pig and chicken erythrocytes at room temperature. Electron microscopy of purified virions revealed spherical to icosahedral particles measuring 70-85 nm in diameter with a double capsid layer. Preparations of the viral genome contained ten segments of dsRNA when analyzed by polyacrylamide gel electrophoresis. A juvenile black ratsnake (Elaphe obsoleta obsoleta) was experimentally inoculated with the isolate and was found dead 26 days post inoculation. Necropsy revealed diffuse subacute interstitial pneumonia with respiratory epithelial cell hyperplasia and syncytia. Reovirus isolated from this snake was used to inoculate another juvenile black ratsnake which was euthanized 40 days post inoculation. Pneumonia and multifocal subacute proliferative tracheitis were found on necropsy. Reovirus was isolated from the lung of this snake and was demonstrated by transmission electron microscopy. This is the first documentation of a pathogenic reptile reovirus and the first report of experimental transmission of a reovirus in snakes.

Animals↗
PubMed1999

Management of acute inflammatory childhood stridor.

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.

Airway Obstruction↗
PubMed1983

Diquat intoxication.

Reported is the case of a 23-year-old man who ingested 300 mL of Reglone. He developed vomiting five to 10 minutes after ingestion. Shortly thereafter, he developed renal and central nervous system manifestations of toxicity, followed by cardiovascular collapse and death 14 hours after admission. Autopsy findings revealed esophagitis, tracheitis, gastritis, and ileitis. Prompt, aggressive therapy that included fluid replacement and removal of the toxin was unsuccessful.

Adult↗
PubMed1996

[Interdisciplinary therapeutic concept in severe bacterial infections of the central respiratory tract in childhood].

BACKGROUND: Apart from all advances made in the management of central airway infections, Acute Epiglottitis (AE) and Bacterial Tracheitis (BT) continue to be causes of life-threatening airway obstruction in children. The aim of this retrospective study was to evaluate deficiencies in the diagnostical protocol, to clarify the role of airway endoscopy in acute childhood stridor, and to identify current reasons for fatalities in these diseases. MATERIAL: In the observation period between 1980-92, we found 12 patients suffering from BT and 21 from AE managed in close cooperation of the involved disciplines at the pediatric intensive care unit of the University of Cologne. RESULTS: Laryngoscopy with fiberoptic or small rigid endoscopes allowed in awake cooperative children accurate diagnose of AE, and the exclusion of supraglottic inflammation in BT without complications. Furthermore, additional endoscopic information of the degree of inflammation was helpful in the next critical decision, whether artificial airway or rigid tracheobronchoscopy was required. Nasotracheal intubation was necessary in 76% of our patients, in one child tracheostomy was performed (5%). Premature extubation necessitating reintubation occurred in 33% of the children suffering from BT. In these patients, our method of advancing a flexible endoscope for tracheoscopy through the respiration tube failed because of a low tube diameter. Another remarkable finding was the high mortality in AE (14%). Affected children were admitted in poor post-hypoxia conditions following outdoor cardiorespiratory arrest. CONCLUSION: In the analysis of the clinical course we found three decisive turning points in managing the disorder; First, the confirmation of the correct admission diagnosis; second, the decision, as to whether an artificial airway should be established; and third, the proper time of extubation. The most decisive factor in decreasing mortality seems to be timely, appropriate presentation at referral centers if AE or BT is suspected. Clinically, progressive management of childhood stridor requires close cooperation between the Pediatric, Anesthesiologic, and ENT Departments. Fiberoptic endoscopy as a guide to current airway management is a major step forward and should be a part of every established protocol.

Airway Obstruction↗
PubMed1994

Bacterial laryngotracheitis associated with toxic shock syndrome in an adult.

Nonmenstrual toxic shock syndrome (TSS) in adults has been associated with various staphylococcal respiratory tract infections, including pharyngitis, tonsillitis, pneumonia, and postinfluenza respiratory tract infections. In children, nonmenstrual TSS has also been described as a complication of bacterial tracheitis. We describe the case of a 40-year-old woman who presented with laryngotracheitis as well as clinical and laboratory evidence of TSS. Culture of her sputum samples yielded pure growth of Staphylococcus aureus, which was shown to produce TSS toxin 1 (TSST-1). The patient responded promptly to therapy with iv clindamycin. We discuss the association of TSS with staphylococcal laryngotracheitis and the role of clindamycin in the treatment of TSS. To our knowledge, there are no previous reports of TSS complicating laryngotracheitis in adults.

Adult↗