Review Question - QID 104439

This patient is presenting with a high fever, dysphagia, drooling, and respiratory distress which is concerning for a diagnosis of epiglottitis. In vaccinated patients, Streptococcus pneumoniae is a common etiology of epiglottitis.

Epiglottitis has a rapid onset (1-3 hours) and presents with a high fever, dysphagia, drooling, and stridor. Historically, the most common infectious etiology was Haemophilus influenzae; however, in the setting of modern vaccinations other more common causes include Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. The management of this condition is immediate intubation in the operating room as any possible perturbation of the patient's airway could lead to airway loss. Antibiotics that could be appropriate include ceftriaxone, cefotaxime, and cefuroxime.

Incorrect Answers:
Answer 1: Candidia albicans can cause epiglottitis but usually this would only occur in a very ill and immunocompromised patient.

Answer 2: Epstein-Barr virus can cause infectious mononucleosis which presents with fatigue, malaise, splenomegaly, posterior cervical lymphadenopathy, and tonsillar exudates. It would not cause epiglottitis.

Answer 3: Haemophilus influenzae is the most common cause of epiglottitis in unvaccinated patients; however, it is a more rare cause (though still possible) in vaccinated patients.

Answer 5: Streptococcus viridans is normal flora in the mouth and could cause bacterial endocarditis after a dental procedure in a patient with an abnormal or mechanical valve.

Bullet Summary:
Common causes of epiglottitis in vaccinated patients include Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.