Children with stridor, fever, and suspected epiglottitis often undergo general anesthesia and laryngoscopy for the evaluation and management of airway obstruction. In the presence of normal supraglottic structures, a diagnosis of viral croup is often made and endotracheal intubation avoided. However, recent reports in the pediatric and otolaryngologic literature reveal a reemerging cause of life-threatening infectious airway obstruction not visualized by standard laryngoscopy (1-6). We present a child with bacterial tracheitis and review the experience of others with this potentially life-threatening disorder. Case ReportA five-yr-old white male with a history of four previous episodes of uncomplicated croup developed fever to 39°C six days prior to admission and cough two days prior to admission with increasing respiratory distress on the day of admission. On admission, the child had a temperture of 38.5"C, severe sternal and intercostal retraction, and marked inspiratory and expiratory stridor. White blood cell count was 12,000 with 56% neutrophils, 8% bands, 16% lymphocytes, and 20% monocytes. Epiglottitis was suspected, and the child was immediately transferred to the operating room where laryngoscopy under halothane anesthesia was performed. The epiglottis was found to be normal, but copious purulent secretions were suctioned from the trachea. Attempts to pass a 4.5-mm orotracheal tube through the subglottic area were unsuccessful. A 4.0-mm orotracheal tube was, therefore, inserted and, after tracheobronchial suctioning, the patient emerged from anesthesia and was transferred to the recovery room, where respirations were controlled with an FI,~ of 0.5. A portable chest roentgenogram obtained in the recovery room showed a paReceived from the