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EPIGLOTTITIS

1. Introduction • Epiglottitis = acute inflammation of the epiglottis and adjacent supraglottic structures. • Life-threatening upper airway obstruction if not managed urgently. • Previously common in children, but now more in adults due to Hib vaccination. 2. Etiology A. Infectious Causes • Bacterial (most common): • Haemophilus influenzae type b (Hib) – historically most common in children. • Streptococcus pneumoniae • Streptococcus pyogenes • Staphylococcus aureus • Viral: Herpes simplex, Varicella. • Fungal: Candida albicans (immunocompromised). B. Non-infectious Causes • Thermal injury (hot liquids, steam inhalation). • Caustic ingestion. • Trauma to epiglottis. 3. Epidemiology • Before Hib vaccine → children 2–7 years most affected. • After Hib vaccine → adult cases rising. • Male slight predominance. 4. Pathophysiology • Infection → rapidly spreading edema of epiglottis & aryepiglottic folds. • Narrow supraglottic airway → high risk of sudden obstruction. • Edematous, cherry-red epiglottis (“cherry on top” sign). 5. Clinical Features A. Classical Pediatric Presentation — “3 D’s” 1. Dysphagia (painful swallowing) 2. Drooling 3. Distress / Dyspnea Other features: • Sudden onset high fever. • Sore throat (disproportionately severe compared to oropharyngeal findings). • Tripod position — child leans forward with extended neck to improve airway. • Muffled “hot-potato” voice. B. Adult Presentation • Gradual onset sore throat. • Odynophagia ,dysphagia. • Hoarseness. • Stridor is less common but dangerous when present. 6. Diagnosis A. Clinical Diagnosis • Avoid unnecessary oral examination → may precipitate obstruction. • Secure airway first if distress present. B. Investigations • Lateral neck X-ray: • “Thumb sign” → swollen epiglottis. • Only if patient stable. • Flexible nasopharyngolaryngoscopy: • Cherry-red swollen epiglottis. • Blood culture & throat swab. • CBC: Leukocytosis. • Pulse oximetry & ABG if respiratory compromise. 7. Differential Diagnosis • Croup (Laryngotracheobronchitis) → gradual onset, barking cough, steeple sign on X-ray. • Peritonsillar abscess. • Retropharyngeal abscess. • Angioedema. • Foreign body. 8. Complications • Sudden airway obstruction (most feared). • Aspiration pneumonia. • Septicemia. • Mediastinitis (rare). • Death if untreated. 9. Management A. Emergency Approach (Airway First) • Do NOT agitate patient. • Call anesthesia & ENT immediately. • Prepare for controlled intubation. • If intubation impossible → emergency tracheostomy. B. Medical Treatment • Admit to ICU. • IV antibiotics: • Ceftriaxone or Cefotaxime. • Alternative: Ampicillin-sulbactam. • IV dexamethasone → reduces edema. • Humidified oxygen. • IV fluids. C. Supportive Care • Keep child upright. • Avoid throat examination unless in OT. • Vaccinate unprotected contacts with Hib vaccine. 10. Prevention • Hib vaccination → has drastically reduced childhood cases. • Adult cases often unpreventable but early recognition crucial.