title: Tracheobronchitis caused by methicillin-resistant Staphylococcus aureus as a cause of chronic wheezing in a non-ventilated adult patient with tracheobronchomalacia.
abstract: Bacterial tracheobronchitis is an extremely rare entity, which was long considered to be a pediatric disease. We report the case of a 65-year-old woman who presented with persistent wheezing, worsening productive cough and sore throat. Computed tomography of the chest revealed the presence of tracheomalacia, confirmed at bronchoscopy. The presence of purulent exudate, coating the trachea and main bronchi, was consistent with bacterial tracheobronchitis. Culture of the tracheal aspirates grew methicillin-resistant Staphylococcus aureus (MRSA). As the patient was afebrile and not systemically ill, the clinical picture was consistent with exudative tracheobronchitis. To our knowledge, this is the first case of MRSA exudative tracheobronchitis and tracheomalacia in a non-ventilated adult. Other adult cases of bacterial tracheobronchitis and MRSA tracheobronchitis in mechanically ventilated patients reported in the literature are also reviewed.Physicians should be aware of the diagnosis of tracheomalacia in adults, which can masquerade as persistent asthma and may be associated with the development of serious infections including MRSA tracheobronchitis.
authors.affiliation: Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. tkelesid@gmail.com
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kelesidis
authors.forename: Sara
authors.initials: S
authors.lastname: Osman
authors.forename: Edward
authors.initials: E
authors.lastname: Trayner
authors.forename: Michael
authors.initials: M
authors.lastname: Worthington
authors.forename: Bartolome
authors.initials: B
authors.lastname: Celli
mesh_terms: D000368:Aged; D001991:Bronchitis / Q000150:complications / Q000382:microbiology*; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012135:Respiratory Sounds / Q000209:etiology; D013203:Staphylococcal Infections / Q000150:complications*; D014136:Tracheitis / Q000150:complications / Q000382:microbiology*; D055090:Tracheomalacia / Q000150:complications*