Acute tracheobronchitis

Case report:

In practice a 65 year old patient comes with a well-known since longer diabetes mellitus type II, complaining of cough and purulent expectoration. It started the disease a few days ago with body aches, headache, weakness, frailty, runny nose and dry cough and fever with increasing tendency to a maximum of 39 � C. For two days the cough was suddenly connected to ejection which has turned greenish-yellowish; breathlessness on exertion was also encountered. Physical examination shows a normal respiratory rate in an indicated lower cyanosis, on lung isolated dry bronchitic sounds are heard especially at faster expiration. When inspecting the pharynx showed in the rear pharyngeal remnants of a purulent secretion. The examination of the paranasal sinuses does not make pressure pain, the further physical examination provides no abnormalities.

Diagnosis and Etiology:

The acute tracheobronchitis is usually a viral infection, wherein influenza and parainfluenza, RS and adenoviruses are the main pathogens. In particular, patients at risk, but also in people without underlying disease, it can lead to bacterial superinfection after the primary viral infection mostly by reducing the bronchial clearance mechanisms. By far the most common bacterial pathogens such purulent tracheobronchitis are Haemophilus influenzae and pneumococcus. In a microbiological examination may be dispensed with uncomplicated cases thoroughly, especially an adequate sputum logistically very demanding with fast transport routes and optimal work-up in the microbiology laboratory.

Therapy:

In by far the dominant bacteria pneumococci and Haemophilus influenzae can be treated in Germany definitely still with Aminobenzylpenicillinen as amoxicillin (inter alia Amoxypen). Only pretreatments and / or other serious risk factors such as liver cirrhosis, renal failure, advanced age or's recent hospitalization should oral cephalosporin [eg Cefuroxime axetil (ELOBACT et al)] or fluoroquinolones group III or IV [levofloxacin (Tavanic), moxifloxacin (Avelox)] are used. In young, non-smoking and otherwise healthy patients can also be dispensed with antibiotic therapy, which has been shown in controlled studies. The duration of treatment should usually not exceed five to seven days.