Tracheitis in a laryngectomee due to Gram-negative bacteria

 

Laryngectomees run the risk of developing respiratory tract infections. A laryngectomee who developed trachitis is presented Brook to illustrate the risks and difficulties encountered in managing this infection in neck breather.

The patient presented with coughing of viscous green purulent sputum. He has been wearing a heat moisture exchanger filter (HME) spoke through a tracheo-esophageal voice prosthesis. The symptoms started 2 days after his voice prosthesis started to leak whenever he consumed liquids.

Sputum culture grew heavy growth of Klebseilla oxytoca, and Moraxella catararhalis, and medium growth of Stenothrophomonas (Xanthohmonas) maltophilia. The patient recovered after he was treated with oral levofloxacin  for 5 days. Humidification of the trachea and the airway was maintained by repeated insertions of 3-5 cc respiratory saline into the stoma at least once every two hours; and by breathing humidified air. The leaking voice prosthesis was replaced enabling the patient to consume adequate amount of fluids.

This is the first report of bacterial tracheitis due to multiple Gram-negative aerobic and facultative bacteria in a laryngectomee. The etiology of tracheitis in this patient is most likely due to aspiration of oral flora that contained these organisms through the leaking voice prosthesis (, or their acquisition through the stoma. A change in the consistency and color of the sputum was most likely due to the tracheal inflammation caused by these organisms. Obtaining a bacterial culture enabled their recovery and adequate elimination. 

Laryngectomees are at risk of aspirating liquids containing bacteria. When unclean liquids get into the lower respiratory tract, they can sometimes cause infection. Developing aspiration pneumonia depends on how much liquid is inhaled and how much is coughed out, as well as on the individuals' immune system.

This report highlights the importance of obtaining bacterial cultures and antimicrobial susceptibility that enabled eliminating the pathogens and restoring adequate mucus production. Treatment with a short course of antimicrobial as well as maintaining adequate hydration and respiratory tract humidification can restore the adequacy of the mucus.