Epiglottitis

Epiglottitis
Classification and external resources
ICD-10	J05.1
ICD-9	464.3, 476.1
DiseasesDB	4360
eMedicine	emerg/169 emerg/375 ped/700
MeSH	D004826

Epiglottitis is inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency. The infection can cause the epiglottis to either obstruct or completely close off the windpipe.
With the advent of the Hib vaccine, the incidence has been reduced,^[1] but the condition has not been eliminated.^[2]

Contents 1 Signs and symptoms 2 Cause 3 Diagnosis 4 Management 5 Complications

Signs and symptoms

Epiglottitis typically affects children, and is associated with fever, difficulty in swallowing, drooling, hoarseness of voice, and stridor. It is important to note however that since the introduction of the Hemophilus influenzae vaccination in many Western countries (including the UK) has lowered childhood incidence while adult incidence has remained the same, the disease is becoming relatively more common in adults than children^[3]. The child often appears acutely ill, anxious, and has very quiet shallow breathing with the head held forward, insisting on sitting up in bed. The early symptoms are insidious but rapidly progressive, and swelling of the throat may lead to cyanosis and asphyxiation.^{[citation needed]} Cases in adults are most typically seen amongst abusers of crack cocaine and have a more subacute presentation. George Washington is thought to have died of epiglottitis.^[4]

Cause

Epiglottitis involves bacterial infection of the epiglottis, most often caused by Haemophilus influenzae type B, although some cases are attributable to Streptococcus pneumoniae , Streptococcus agalactiae, Staphylococcus aureus, and Streptococcus pyogenes.

Diagnosis

Diagnosis is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. If it is suspected, attempts to visualise the epiglottis using a tongue depressor are STRONGLY discouraged for this reason. A paediatric, anaesthesia or ENT specialist should be alerted immediately. Imaging is rarely useful, and treatment should not be delayed for this test to be carried out.^[5]
The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates are croup, peritonsillar abscess, and retropharyngeal abscess.
On lateral C-spine X-ray, the thumbprint sign (or just "thumb sign") describes a swollen enlarged epiglottis.^[6] Written By: Herberth R Solorzano Oklahoma State University Oklahoma City Ok

Management

Epiglottitis requires urgent tracheal intubation to protect the airway. given in the initial stages to reduce symptoms, but this will not treat the underlying cause. It should also be noted that if stridor becomes quieter, obstruction is likely to follow, and thus intubation should be expedited even further.^[5]
In addition, patients should be given antibiotic such as second- or third generation cephalosporins (either alone or in combination with penicillin or ampicillin for streptococcal coverage).

Complications

Some patients may develop pneumonia, lymphadenopathy or septic arthritis.