Generality
Tracheitis is the inflammation of the trachea, the elastic and flexible conduit that joins the larynx (the last element of the upper airway) to the primary bronchi (first structures of the bronchial tree).
The bacteria most frequently involved in the appearance of tracheitis are Staphylococcus aureus and Streptococcus pneumoniae.
A classic tracheitis due to infectious agents produces: cough, runny nose, fever, retrosternal pain, abnormal sound emission during breathing (stridor and rattle) and difficulty breathing.
If the inflammation is particularly severe, the trachea can become completely blocked and the patient goes into respiratory arrest.
Accurate diagnosis allows you to plan the most appropriate treatment. In particularly serious cases, immediate treatment and hospitalization are needed.
What is tracheitis?
Tracheitis is inflammation of the trachea .
WHAT IS TRACHEA? ANATOMICAL BRIEF RECALL
Located between the larynx and the bronchi, the trachea is that elastic and flexible conduit that constitutes the first part of the lower airways.
The trachea is usually 12 centimeters long and has a diameter of about 2 centimeters.
Above, it originates from the cricoid cartilage of the larynx (about the height of the sixth cervical vertebra); inferiorly, it ends at the bifurcation from which the primary bronchi arise. The primary (or main) bronchi are the starting point of the so-called bronchial tree (extrapulmonary primary bronchi, secondary and tertiary bronchi, bronchioles, terminal bronchioles and respiratory bronchioles).
Regarding the neighboring elements, behind the trachea resides the esophagus - conduit of the digestive system that introduces the food inside the stomach; while at its sides, the nerve-nerve bundles of the neck are placed.
Causes
To learn more: Tracheitis: Causes and Symptoms
Tracheitis can have numerous causes.
In most cases, it is the result of a bacterial ( bacterial tracheitis ) or viral ( viral tracheitis ) infection .
More rarely, it can appear due to circumstances or irritative factors, such as:
- Involuntary inhalation of objects, which, by stopping in the trachea, cause inflammation.
- Smoking . Cigarette smoking is an irritant throughout the entire respiratory tract. Moreover, it is a factor favoring respiratory infections.
Generally, the inflammations it causes are chronic.
- Environmental, domestic or work pollution . If the inhaled air contains pollutants or irritating substances for the respiratory mucosa, it can cause inflammation of the airways that it passes through (especially the trachea and bronchial tree).
Environmental, domestic or work pollution is mostly associated with chronic inflammation of the respiratory tract.
- Inhalation of pollen, dust, animal hair and similar substances by allergy sufferers.
BACTERIAL TRACHEITE AND VIRAL TRACHEITE
Premise: tracheitis due to infectious agents can derive from an infection borne directly by the trachea ( primary tracheitis ) or from an infection born in a tract of the upper airways and extended, only later, to the trachea ( secondary tracheitis ).
The bacteria that can cause a tracheitis are:
- Staphylococcus aureus . It is the bacterial agent at the origin of most cases of tracheitis.
Generally, it colonizes the skin, cutaneous glands and upper respiratory tract and causes boils and abscesses.
Less frequently, it affects the internal organs and is responsible for gastroenteritis, osteomyelitis, septic arthritis, pneumonia, meningitis, endocarditis, septicemia and the so-called toxic shock syndrome.
Staphylococcus aureus- induced tracheitis can be primary or secondary; when it is secondary it derives from an infection affecting the nasopharyngeal tract (ie rhinitis, pharyngitis or laryngitis).
- MRSA . It is a particular strain of Staphylococcus aureus, resistant to the methicillin antibiotic. In fact, MRSA is the acronym of Methicillin Resistant Staphylococcus Aureus .
From the point of view of the consequences following its colonization, it is very similar to the normal Staphylococcus aureus: it causes mainly abscesses and boils, but occasionally it can also cause endocarditis, pneumonia, septic arthritis, osteomyelitis and septicemia.
The tracheitis that can result from an MRSA infection can be primary or secondary.
- Streptococcus pneumoniae . It is the bacterial agent famous for causing pneumonia in adults.
In reality, however, it can also have other consequences, some mild and others decidedly more severe.
The mild conditions include bronchitis, conjunctivitis, otitis media, sinusitis and precisely tracheitis; on the other hand, serious conditions include, in particular, septic arthritis, bacteremia, infectious cellulite, meningitis, osteomyelitis, pericarditis and peritonitis.
Streptococcus pneumoniae tracheitis can be both primary and secondary; if it is secondary, it generally derives from a sinusitis.
- Haemophilus influenzae . It is a class of bacteria that predominantly colonizes the upper airways and the lower lower airways.
Generally, it is responsible for sinusitis, otitis media and bronchitis; more rarely it causes pneumonia and meningitis.
The tracheitis that can appear following an infection with Haemophilus influenzae is often the result of sinusitis, so it is secondary.
- Moraxella catarrhalis . It is a typical colonizer of the upper and lower airways.
Usually, it causes the appearance of sinusitis, laryngitis, bronchitis and otitis media.
Only in rare cases does it induce the appearance of more serious conditions, such as: pneumonia, urethritis, septic arthritis and septicemia.
The trachyte supported by Moraxella catarrhalis is generally of secondary type, deriving from episodes of sinusitis or laryngitis.
- Klebsiella pneumoniae . It is a bacterial agent that, in most cases, infects the upper airway and the urinary tract and, only in rare cases, causes meningitis, osteomyelitis, pneumonia and bacteremia.
Klebsiella pneumoniae- associated tracheitis is mostly secondary.
Moving on to viral tracheitis, the viruses that can cause them are: influenza viruses, cold viruses (or rhinoviruses ) and parainfluenza viruses .
Generally, the inflammation of the trachea caused by these viral agents is secondary, as it derives from some form of rhinitis, pharyngitis or laryngitis.
RISK FACTORS
There is an increased risk of developing different tracheitis, including: direct or indirect contact with people with the aforementioned infectious agents, a state of immunodepression, living in a very polluted city, doing a job where you can breathe airway irritants daily and be avid smokers.
What does immunodepression mean briefly?
In medicine, the term immunodepression indicates a pathological decrease in immune defenses; immune defenses whose task is to defend the body from external threats (viruses, bacteria, fungi, etc.) and from the inside (cancer or malfunctioning cells).
Among the main causes of immunodepression, special mention should be made of: infectious diseases such as AIDS and the intake of immunosuppressive and anticancer drugs.
Symptoms and Complications
To learn more: Symptoms Tracheitis
Since most cases of tracheitis are due to an infection, this article deals specifically with the symptomology of infectious tracheal inflammation.
Therefore, in light of this necessary premise, the symptomatological picture that characterizes the aforementioned inflammatory states generally consists of:
- Severe and deep cough
- Temperature
- A runny nose
- Emission of a sound similar to something that screeches during the breath. Doctors speak more simply than grating.
- I gasp during breathing
- Retrosternal or chest pain. This sensation is accentuated with coughing.
- Sore throat, nasal congestion, sneezing, hoarseness and / or swallowing pain. They are three typical manifestations of secondary tracheitis, following the presence of rhinitis, pharyngitis or laryngitis.
- Slight breathing difficulties. Comparable to a breathlessness during breathing, they are the result of a generalized edema, located inside the trachea, which causes the narrowing of the latter. Through a narrow trachea, the air passes with greater difficulty.
Cough, runny nose and fever are typical of the onset phase. On the other hand, respiratory anomalies (stridor, breathlessness, etc.) and retrosternal pain characterize the later stage of inflammation, generally appearing between 2 and 5 days after the first manifestations.
Symptoms resulting from a condition of rhinitis, pharyngitis or laryngitis may be present even before the trachea becomes inflamed or arise along with the later ones.
COMPLICATIONS
In the presence of a very severe tracheitis, the edema inside the trachea is severe to the point of drastically reducing the passage of air directed to the lungs. This causes worsening of breathing difficulties and the appearance of cyanosis .
With the term cyanosis, doctors indicate that condition in which blood contains an insufficient amount of oxygen (NB: it is an effect of the reduction of alveolar exchanges) and the skin takes on a bluish-violet color.
If the trachea undergoes a total occlusion and if the patient is not helped in time in these conditions, the tracheitis can lead, first, to respiratory arrest and, then, to death.
Complications in case of STA infections
In the case of Staphylococcus aureus tracheitis, the patient could develop the so-called toxic shock syndrome ( TSS ), a multisystem inflammatory condition.
Particularly widespread among women, TSS is the cause of: high fever, dizziness (from hypotension), nausea, vomiting, diarrhea, sore throat, muscle pain, weakness, chills, bleeding problems and skin desquamation.
WHEN TO REFER TO THE DOCTOR?
You should contact your doctor immediately or go to the nearest hospital, if:
- The fever is very high and shows no signs of diminishing with the passing of days.
- Breathing difficulties worsen instead of improving.
- Cyanosis appears.
- The cough becomes more and more serious and there are serious difficulties in swallowing food.
Diagnosis
The physical examination, including a careful assessment of respiratory capacity, is often sufficient to diagnose the presence of tracheitis.
However, doctors still use more specific tests, as they want to:
- Have greater certainty about the problem in progress;
- Understanding whether the nature of the possible ongoing tracheitis is bacterial or not;
- Clarify the seriousness of the situation.
To achieve these three objectives, the following are fundamental: oximetry, culture tests on the cells of the nasopharyngeal tract and possibly also of the tracheal tract and, finally, the control of the trachea with X-rays.
EXAMINATION OBJECTIVE
The first part of the objective examination consists in the request by the doctor to the patient to describe the symptoms present (if the patient is a child, the people questioned are the parents or adults who spend more time with him). In general, the most common questions - because they are most significant for diagnostic purposes - are:
- What are the symptoms?
- When did the first demonstrations appear? Did they arise after a particular circumstance? (NB: these two questions help to establish whether the alleged tracheitis may have a non-infectious nature).
- Did you experience a worsening in terms of symptoms?
- Are there moments of the day when the problems get worse?
The second part of the physical examination, on the other hand, requires the physician to assess the patient's respiratory capacity in the first person, searching for any difficulties or abnormal sounds (rattling, stridor, etc.) during breathing.
Other important questions
During the physical examination, the doctor also investigates if the patient is a smoker, attends particularly polluted places, is allergic to particular substances, etc.
This information further clarifies the causes of the symptoms, especially in those cases where the hypothesis of an infectious tracheitis is to be discarded.
OXIMETRY
Oximetry is a very simple and immediate test that measures oxygen saturation in the blood.
For its execution, the doctors use a particular device, called the oximeter, which they apply on a finger or a lobe of the patient's ear (in both cases, they are two highly vascularized anatomical areas).
Low oxygen saturation in the blood indicates that breathing difficulties (such as those that can induce tracheitis) are of some significance and deserve appropriate care.
CULTURAL TESTING OF THE NOSEFARINGE AND THE TRACHE
Culture tests on a sample of cells, appropriately taken, make it possible to clarify two aspects:
- Determine if the individual who provided the aforementioned sample suffers from some bacterial infection.
- Identify the bacterium involved.
From a procedural point of view, they consist in inoculating the cell sample in different culture media, each of which is suitable for the growth of a precise bacterium, and to see where a bacterial proliferation takes place. The soil in which bacterial growth is observed makes it possible to establish the bacterium involved in the infection. For example, if there is a proliferation of bacteria in the culture for the growth of MRSA, it means that MRSA is the bacterium that caused tracheitis.
In the presence of suspected tracheitis, justifying the performance of culture tests on the cells of the nasopharyngeal and tracheal tract is the fact that, as already mentioned in other sites, the inflammation of the trachea often has a bacterial origin.
The identification of the responsible bacterium allows the doctor to plan the most appropriate treatment.
- Culture test on a sample of nasopharyngeal tract cells (nasopharyngeal culture): sample collection is simple and immediate and does not cause particular discomfort to the patient. The cells come from the nasal mucosa or from the mucosa of the throat.
Any presence of bacteria in this area means that, probably, the tracheitis is of secondary type (that is it derives from a form of rhinitis or pharyngitis).
- Culture test on a sample of tracheal tract cells (tracheal culture): the collection of the cell sample is quite complex and requires the sedation of the patient, because otherwise the latter would feel pain.
The use of tracheal culture occurs only in particular cases, when for example the symptomatology is severe or when the doctor suspects a severe bacterial infection (of which it is necessary to know immediately the responsible pathogen).
X-RAYS TO THE TRACHEA
An X-ray scan of the trachea provides a fairly clear picture of the duct that joins the larynx to the bronchi. Therefore, it allows the doctor to outline what is the state of health of the tracheal duct and what has caused the inflammation against him.
Treatment
The treatment of tracheitis depends on at least two factors, which are: the cause of inflammation against the trachea and the severity of the current condition.
The cure of the triggering factors is fundamental for achieving healing, while a therapy based on the symptoms in progress allows to avoid unpleasant, sometimes even dramatic, consequences.
THERAPY OF BACTERIAL TRACHEITE
Bacterial tracheitis requires treatment with antibiotic drugs .
The choice of antibiotics to be administered is the responsibility of the attending physician and depends on the bacterial agent that triggered the inflammation of the trachea (NB: this is why the culture test is important).
During the antibiotic treatment, it is good that the patient adheres to some important medical recommendations, valid every time an infection is present, such as: absolute rest for a few days, constant intake of liquids to avoid dehydration and the use of non-steroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms.
THERAPY OF VIRAL TRACHEITE
A viral tracheitis does not usually require special pharmacological treatments. In fact, it is very rare that, in these situations, doctors administer antiviral drugs .
In these situations, the observance of medical recommendations, mentioned earlier and useful every time an infection is present, is of fundamental importance, that is: absolute rest, constant supply of liquids to prevent any episodes of dehydration and the use of NSAIDs to reduce the symptomatology.
TRACHEITE THERAPY FROM ALLERGENS
A tracheitis due to allergens requires, first of all, the identification of the triggering factor and its exclusion from the environment in which the patient usually lives; secondly, the treatment with antihistamines and / or cortisone drugs, whose purpose is to reduce the allergic reaction.
THERAPY IN CASE OF SERIOUS TRACHEITE
Regardless of the causes, the severe cases of tracheitis require immediate hospitalization, because they need respiratory support .
This respiratory support occurs through the insertion, in the patient's trachea, of an endotracheal tube, connected to a machine for mechanical ventilation .
The use of respiratory aid ends when the patient shows clear improvements and is able to breathe independently and with good results.
During hospital admission, the pharmacological administration of antibiotics (in the specific case of bacterial tracheitis) and anti-inflammatory drugs takes place intravenously.
Prognosis
The prognosis of mild tracheitis is generally positive, with the patient recovering completely and without permanent consequences of any kind.
In contrast, the prognosis of severe tracheitis can be decidedly negative, especially when there is a delay in treatment.
