PEDBASE.org - The Pediatric Database - Detailed information of EPIGLOTTITIS

EPIGLOTTITIS

DEFINITION:

An acute inflammation of the supraglottic larynx characterized by stridor and acute upper airway obstruction and considered a medical emergency.

EPIDEMIOLOGY:

incidence: decreasing due to H. flu immunization
age of onset:
- 2-7 years of age with peak at 3.5 years
risk factors:
- sporadic
- M > F (3:2)

PATHOGENESIS:

1. Etiology

1. Bacterial Pathogens

H. influenzae type b
Group A beta-hemolytic Streptococcus

2. Pathogenesis

infection -> intense inflammation of the supraglottic region -> swelling of the epiglottis, aryepiglottic folds, arytenoid cartilages and ventricular bands -> acute upper airway obstruc-tion

CLINICAL FEATURES:

1. Prodrome

upper respiratory tract infection with sore throat, dysphagia, and high fever
upon presentation, the patient is toxic in appearance

2. Respiratory Manifestations

1. Inspiratory Stridor

worse in supine position and placing patient in the supine position is contraindicated
patients sits erect and leaning forward with chin thrust forward (neck hyperextended), the tongue protruding, and drooling
beware of 4 "D's" - dysphagia, dysphonia, drooling, and distress

2. Acute Upper Airway Obstruction

may range from mild inspiratory and expiratory stridor to severe respiratory distress and arrest
may progress rapidly to an acute upper airway obstruction and subsequent respiratory arrest therefore:
- do not agitate the patient
- do not attempt to place in the supine position
- examination of the throat is contraindicated as this may lead to a reflex laryngospasm -> obstruction - do not attempt blood work or x-rays

3. Complications

1. Other H. flu Infections

meningitis, otitis media, cervical adenitis, pneumonia, septic arthritis

2. Respiratory Manifestations

fulminant pulmonary edema after acute airway obstruction

INVESTIGATIONS:

All contraindicated until the patient is stabilized with a secure airway.

1. Direct Laryngoscopy

performed in the OR
swollen, cherry-red epiglottis

2. Imaging Studies

1. Lateral Neck X-Ray

swollen epiglottis

3. Serum

blood cultures
CBC - leukocytosis with left shift

MANAGEMENT:

1. Supportive

a medical emergency
keep child calm and contact ENT and anesthesia stat
a physician should accompany the patient continually
short-term controlled endotracheal intubation in an OR by an anesthetist and usually lasts for 2-3 days
severe or life-threatening upper airway obstruction may require an emergency trachestomy

2. Medical

IV Cefuroxime for the acute phase then oral Septra for a total antibiotic course of 7-10 days
rifampin prophylaxis for patient and family members
corticosteroids and racemic epinephrine are contraindicated

3. Prognosis

acute phase lasts 2-3 days with excellent recovery if managed appropriately
mortality is 25% in untreated cases

INTERNET LINKS:

The Virtual Hospital - Acute Epiglottitis

Pediatric Database - EPIGLOTTITIS

Pediatric Organization - Pedbase [at] Gmail.com