Laryngitis, Tracheitis, Epiglottitis, and Bronchiolitis: Sore Throat, Change in Voice, Feverora Wheezing Infant in Respiratory Distress

The middle and lower respiratory tract is a very common location for infections in infants and children. Infections of the mucosal surfaces of the larynx, trachea, and bronchial tree account for the majority of all infections in this age group and can be associated with considerable morbidity and even mortality in certain populations. Many viral upper respiratory tract pathogens can also involve the middle and lower respiratory tract, particularly for children experiencing their first infection with the pathogen. Laryngitis may cause sore throat and hoarse voice but can also be associated with tracheitis and even bronchiolitis as the pathogen, infection, and host responses move further down the respiratory tree. Bronchiolitis may also occur as a separate infection in the lower airways presenting as respiratory distress in a young infant with prominent wheezing. Many respiratory viral diseases occur with seasonal patterns, with most cases occurring in the fall, winter, and early spring in temperate climates. In the tropics, some viruses, such as respiratory syncytial virus (RSV), may cause disease sporadically, year round, but epidemics still occur during “rainy” seasons. Bacterial infections can also involve the middle airway. Epiglottitis is a feared condition due to the potential for sudden airway obstruction. Fortunately, the diagnosis of epiglottitis has become quite rare since the introduction of routine childhood immunization against Haemophilus influenzae, serotype B, was once the most common cause of epiglottitis. Bacterial tracheitis can be a secondary bacterial infection following an acute viral infection of the trachea or a consequence of prolonged endotracheal intubation. While the mechanism of injury to the trachea is different, both processes lead to disruption of mucosal integrity, predisposing the patient to a tracheal infection caused by bacteria that normally only colonize the airway.