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| Acutely inflamed epiglottis associated with Haemophilus influenza type B |
Definition
Epiglottitis is a rapidly progressive cellulitis of the epiglottis and adjacent soft tissue structures with the potential to cause abrupt airway obstruction.
Physical finding and Clinical presentation
- Irritability, fever, dysphonia, dysphagia
- Respiratory distress, with child tending to lean up and forward
- Often, drooling or oral secretions
- Often, presence of tachycardia and tachypnea
- On visualization, edematous and cherry red epiglottis
- Often, no classic barking cough as seen in croup
- Possibly fulminant course (especially in children), leading to complete airway obstruction.
- In children, Haemophilus infl uenzae type B is usual.
- In adults, H. infl uenzae can be isolated from blood, epiglottis (about 26% of cases), or both.
- Pneumococci, streptococci, and staphylococci are also implicated.
- Role of viruses in epiglottitis unclear.
- Croup
- Angioedema
- Peritonsillar abscess
- Retropharyngeal abscess
- Diphtheria
- Foreign body aspiration
- Lingual tonsillitis
- Cultures of blood and urine
- Lateral neck radiograph to show an enlarged epiglottis, ballooning of the hypopharynx, and normal subglottic structures
- Radiographs are of only moderate sensitivity and specificity and take time to perform.
- Visualization of the epiglottitis may be safer in adults than in children. In children, visualization and intubation are best done in the most controlled environment.
- Cultures of the epiglottitis
- CBC: may reveal a leukocytosis, with a shift to the left
- Chest x-ray examination: may reveal evidence of pneumonia in almost 25% of cases
- Cultures of blood, urine, and epiglottis, as noted
- Maintenance of adequate airway is critical.
- Early placement of an endotracheal or nasotracheal tube in a child is advised.
- Closely follow adult patient and defer intubation, provided the airway reveals no signs of obstruction.
- H. influenzae in children may be less common because of the availability of the Hib vaccine.
- Use antibiotics such as ceftriaxone, cefotaxime.
