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Epiglottitis

Overview
  • Definition: Acute inflammation of the epiglottis and surrounding tissues, posing a risk of rapid airway obstruction.
  • Most commonly seen in children but can also affect adults.
Etiology
  • Most commonly caused by the bacterium Haemophilus influenzae type b (Hib).
  • Other bacterial causes include Streptococcus pneumoniae, Staphylococcus aureus, and beta-haemolytic streptococci.
Clinical Features
  • Sudden onset of high fever and sore throat.
  • Dysphagia (difficulty swallowing) leading to drooling.
  • Muffled voice or stridor.
  • Severe respiratory distress can develop rapidly.
  • β€œTripod” position: Leaning forward with hands on knees, trying to open the airway.
  • Children may appear anxious or agitated.
Diagnosis
  • Clinical presentation.
  • Lateral neck X-ray (if patient is stable): Can show a ‘thumbprint’ sign due to swollen epiglottis.
  • Direct visualisation: ideally in a controlled setting like the operating room due to risk of airway obstruction.
Management
  • Emergency management: If severe respiratory distress, intubation or tracheostomy may be required.
  • Antibiotics: Ceftriaxone or cefotaxime to cover H. influenzae and other common organisms.
  • Steroids to reduce inflammation.
Prognosis
  • With prompt diagnosis and treatment, prognosis is excellent.
  • Delayed diagnosis and treatment can lead to respiratory obstruction and is potentially fatal.
Key Points
  • Consider epiglottitis in any child with sudden onset of sore throat, high fever, and signs of respiratory distress.
  • Immediate intervention is critical to prevent life-threatening airway obstruction.
  • Epiglottitis has become less common in countries where Hib vaccination is routine, but cases can still occur.

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