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Epiglottitis

Introduction

Epiglottitis is an acute inflammation of the epiglottis, which is a structure in the back of the tongue and above the entrance to the throat. The epiglottis protects the airways from food that is being swallowed. As this condition usually presents in an acute fashion, it is often also called “acute epiglottitis”.

Acute epiglottitis is another life threatening respiratory condition, which can occur suddenly in children. It is an acute inflammation of the epiglottis (thanks to www.humanillnesses.com for this image),which can be caused by an infection with bacteria such as Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus aureus, beta-hemolytic streptococcus or Haemophilus parainfluenzae. In the last few years an intense vaccination program has almost eradicated Haemophilus influenzae cases, but epiglottitis from the other causes is still around.

Symptoms

A previously healthy child suddenly gets a high fever, throat pain, a hoarseness and problems swallowing. Breathing gets faster and the child is fighting to get air. This is an emergency like acute croup and requires the call of an emergency response team (call 911) as the hospital environment is needed for this complex problem.

 Epiglottitis

Epiglottitis

Treatment

A team consisting of an ENT specialist, an anesthesiologist and a pediatrician is usually required for this problem. Initially laryngoscopy may be required to inspect, take cultures and immediately place a small nasotracheal intubation (thanks to calsprogram.org for this link) tube. In this illustration the clear tube is the nasotracheal intubation tube, the smaller red suction tube is for gastric suction to prevent aspiration pneumonia. If this procedure fails, an immediate tracheotomy (an opening between the skin and the trachea) must be made to place an airway. Close observation in an intensive care unit is important to monitor that no further deterioration occurs. Intravenous antibiotics with a betalactamase resistant antibiotic is given until the final culture report and sensitivity tests are back and the antibiotic can be adjusted.

 

References:

1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 161.

2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.

3. F Charatan BMJ 2000 Oct 21;321(7267):980.

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse   Station, N.J., 1999. Chapter 43.

5. JR Zunt and CM Marra  Neurol Clinics Vol.17, No.4,1999: 675-689.

6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse   Station, N.J., 1999. Chapter 162.

7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.

8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.

9. DO Freedman et al. Med Clinics N. Amer. Vol.83, No 4 (July 1999):     865-883.

10. SP Fisher-Hoch et al. J Virol 2000 Aug; 74(15): 6777-6783.

11. Mandell: Principles and Practice of Infectious Diseases, 5th ed., ©   2000 Churchill Livingstone, Inc.

12. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000   W. B. Saunders Company

13. PE Sax: Infect DisClinics of N America Vol.15, No 2 (June 2001):   433-455.

14. David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.

Last modified: October 24, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.