Epidemiology
Among 552 tracheal aspirate cultures analyzed, 113 (25.3%) were linked to tracheobronchitis episodes in 62 children [PMID:39853969].
Clinical Presentation
A 46-year-old woman presented with a 1-week history of progressive dyspnea, cough, fever, and sore throat, ultimately diagnosed with PMTB characterized by severe tracheal stenosis and extensive pseudomembranes obstructing bilateral bronchi [PMID:33353810].
Diagnosis
In a retrospective cohort study of 62 children with tracheostomies, bacterial counts > 10^3 in tracheal aspirates were not significantly associated with episodes of tracheobronchitis [PMID:39853969].
Initial nasolaryngoscopy suggested tracheitis, but bronchoscopy was essential to identify massive pseudomembranes obstructing the bilateral bronchi, confirming the diagnosis of PMTB [PMID:33353810].
In a study of 95 ICU patients with suspected TBFI, bronchoscopic observations including sticky secretions, hyperaemic mucosa, and whitish plaques were key indicators [PMID:23331540].
The study found that BAL (+ fungi) had a sensitivity of 85.1% and specificity of 81.4% in diagnosing TBFI among patients with suspected infections [PMID:23331540].
Management
The study suggests that relying on bacterial counts from tracheal aspirates for diagnosing tracheobronchitis in this population may be unreliable, questioning the current diagnostic approach [PMID:39853969].
Despite urgent tracheotomy to prevent asphyxia, the patient's condition improved markedly following subsequent toilet bronchoscopy, highlighting the importance of both surgical and endoscopic interventions [PMID:33353810].
Given the positive predictive value of 66.3% for BAL (+ fungi) in diagnosing TBFI, empirical antifungal treatment may be warranted in ICU patients [PMID:23331540].
References
1 García-Boyano M, Climent Alcalá FJ, Rodríguez Alonso A, García Fernández de Villalta M, Zubiaur Alonso O, Rabanal Retolaza I et al.. Tracheobronchitis in Noncritically Ill Children With Tracheostomy: Can Quantitative Tracheal Cultures Assist in the Management?. Pediatric pulmonology 2025. link 2 Kawakami N, Ito M, Takahashi K, Moriya T, Saito H, Wakai Y et al.. Pseudomembranous Tracheobronchitis With Severe Tracheal Stenosis and Masked Bronchial Obstruction. The Journal of emergency medicine 2021. link 3 Yazıcıoğlu Moçin O, Karakurt Z, Aksoy F, Güngör G, Partal M, Adıgüzel N et al.. Bronchoscopy as an indicator of tracheobronchial fungal infection in non-neutropenic intensive-care unit patients. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2013. link