Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
Respiration. 2010;80(2):148-56. doi: 10.1159/000273268. Epub 2009 Dec 30.
Bacterial tracheobronchitis is an extremely rare entity, which was long considered to be a pediatric disease. We report the case of a 65-year-old woman who presented with persistent wheezing, worsening productive cough and sore throat. Computed tomography of the chest revealed the presence of tracheomalacia, confirmed at bronchoscopy. The presence of purulent exudate, coating the trachea and main bronchi, was consistent with bacterial tracheobronchitis. Culture of the tracheal aspirates grew methicillin-resistant Staphylococcus aureus (MRSA). As the patient was afebrile and not systemically ill, the clinical picture was consistent with exudative tracheobronchitis. To our knowledge, this is the first case of MRSA exudative tracheobronchitis and tracheomalacia in a non-ventilated adult. Other adult cases of bacterial tracheobronchitis and MRSA tracheobronchitis in mechanically ventilated patients reported in the literature are also reviewed.Physicians should be aware of the diagnosis of tracheomalacia in adults, which can masquerade as persistent asthma and may be associated with the development of serious infections including MRSA tracheobronchitis.
细菌性气管支气管炎是一种极为罕见的疾病，长期以来被认为是一种儿科疾病。我们报告了一例 65 岁女性患者，其表现为持续性喘息、咳嗽加剧和喉咙痛。胸部 CT 显示存在气管软化，支气管镜检查予以证实。气管和主支气管有脓性渗出物，符合细菌性气管支气管炎的表现。气管抽吸物的培养结果为耐甲氧西林金黄色葡萄球菌（MRSA）。由于患者无发热且无全身不适，临床表现与渗出性气管支气管炎一致。据我们所知，这是首例非机械通气成人 MRSA 渗出性气管支气管炎和气管软化病例。我们还回顾了文献中报道的其他成人细菌性气管支气管炎和机械通气患者 MRSA 气管支气管炎的病例。医生应该意识到成人气管软化的诊断，它可能表现为持续性哮喘，并可能与包括 MRSA 气管支气管炎在内的严重感染的发生相关。
