Bacterial tracheitis: When croup is not what it seems

Croup or viral laryngotracheobronchitis is a very common paediatric condition. It presents with inspiratory stridor, barking cough and sometimes respiratory distress, following a viral upper respiratory tract infection. The condition has a very good prognosis and responds well to therapy, if required. However, other conditions may mimic it and doctors are always aware of the need to exclude a foreign body aspiration and not to overlook a potential life threatening epiglotittis, much less common now with the successful immunisation against Haemophilus influenzae type B (HiB). A less well known respiratory tract infection, bacterial tracheitis, can also mimic croup. As it is potentially fatal if unrecognised, it is vital to diagnose it early. Luckily, if suspected early, an immediate and specific management is associated with an excellent prognosis. We describe two children, initially managed as croup, who developed this condition. We discuss when bacterial tracheitis should be suspected, how to differentiate it from the extremely common croup, and how to diagnose and treat it.