• 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 α-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.
(Am J Dis Child 1983;137:764-767)