Updated: 12/17/2019

Epiglottitis

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Snapshot
  • A 3-year-old boy is brought to the ER with an abrupt onset of fever (40 degrees Celsius), respiratory distress, and stridor. On examination, the boy appears acutely ill. He is sitting, leaning forward with his mouth open, and drooling.
Introduction
  • A medical emergency and cause of life threatening airway obstruction
    • serious and rapidly progressive infection of the epiglottis and contiguous structures
  • Epidemiology
    • affects children from age 3-7
    • worldwide incidence has deceased with use of the H. flu vaccine and is now more commonly caused by S. pneumoniae or S. pyogenes in vaccinated populations 
  • Organism
    • most commonly caused by Haemophilus influenzae type B
Presentation
  • Symptoms
    • rapid onset (1-3 hours) of
      • high fever
      • dysphagia
      • drooling
      • muffled voice
      • respiratory retractions
  • Physical exam
    • cyanosis
    • soft stridor 
    • patients sit with neck hyperextended and chins protruding (sniffing dog position)
Evaluation
  • Radiographs
    • lateral neck x-ray shows
      • swollen epiglottis (thumbprint sign
      • thickened aryepiglottic folds
      • obliteration of the valleculae
      • a physician should escort the child to radiology prepared to establish an airway
  • Throat swap
    • throat swab for culture will show Haemophilus influenzae type B
  • Fiber optic examination
    • do not examine patient's throat unless an anesthesiologist is present
    • used to confirm diagnosis
    • will see cherry red and swollen epiglottis and arytenoids
Differential
  • Croup, tracheitis, foreign body, retropharyngeal abscess, angioedema, laryngomalacia, vascular ring
    • cough is specific for croup
    • drooling is specific for epiglottitis
    • laryngomalacia improves in the prone position
    • vascular ring improves with neck extension
Treatment
  • Endotracheal intubation
    • call anesthesiology and prepare to establish airway
    • transfer to OR to perform exam
  • Tracheostomy
    • if necessary to maintain airway
  • IV antibiotics
    • ceftriaxone
    • chloramphenicol
    • ampicillin

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(M2.PD.13.9) A 5-year-old boy presents to the emergency department with a sore throat and trouble breathing. His mother states that his symptoms started last night and have rapidly been worsening. The patient is typically healthy, has received all his childhood immunizations, and currently takes a daily multivitamin. His temperature is 103°F (39.4°C), blood pressure is 100/64 mmHg, pulse is 155/min, respirations are 29/min, and oxygen saturation is 95% on room air. Physical exam is notable for an ill-appearing child who is drooling and is leaning forward to breathe. He does not answer questions and appears very uncomfortable. He will not comply with physical exam to open his mouth for inspection of the oropharynx. Which of the following is the most likely infectious etiology of this patient's symptoms?

QID: 104439
1

Candidia albicans

4%

(4/110)

2

Epstein-Barr virus

23%

(25/110)

3

Haemophilus influenzae

13%

(14/110)

4

Streptococcus pneumoniae

58%

(64/110)

5

Streptococcus viridans

1%

(1/110)

M 6 E

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EXPERT COMMENTS (6)
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