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.
• “Tripod” 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.