Bacterial tracheitis.

During a two-year period, 17 children were brought to the St Paul Children's Hospital with the clinical features of croup, unresponsive to conventional therapy; 12 of these were seen during a two-month outbreak of parainfluenza virus type 1 that occurred in the community. Bronchoscopy showed copious purulent tracheal secretions. Cultures of transbronchoscopic aspirates were positive for bacterial organisms, the most common being Staphylococcus aureus (six of 17) and alpha-hemolytic Streptococcus (seven of 17). Four of these children, all treated conservatively with observation and/or endotracheal intubation, suffered a cardiorespiratory arrest, and two of them died. In contrast, one of 13 children who underwent tracheostomy died. Bacterial tracheitis clinically resembles viral croup, but carries a significant morbidity and mortality. Bronchoscopy documenting the presence of copious endotracheal pus and prompt tracheostomy may reduce the complications of this disease.