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.
