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Key Features

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  • Incidence has decreased dramatically due to Haemophilus influenzae conjugate vaccine

  • Rare in countries with immunization programs

  • If disease occurs, it is likely to be associated with

    • H influenzae in unimmunized children

    • Nontypeable H influenza

    • Neisseria meningitides

    • Streptococcus species

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Clinical Findings

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  • Sudden onset of high fever

  • Dysphagia

  • Drooling

  • Muffled voice

  • Inspiratory retractions

  • Cyanosis

  • Soft stridor

  • Progression to total airway obstruction may occur and result in respiratory arrest

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Diagnosis

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  • Lateral neck radiographs

    • May be helpful in demonstrating a classic "thumbprint" sign caused by the swollen epiglottis

    • Obtaining radiographs, however, may delay important airway intervention

  • Direct inspection of the epiglottis

    • Provides definitive diagnosis

    • Should be done by an experienced airway specialist under controlled conditions (typically in the operating room during intubation)

    • Typical findings are a cherry-red and swollen epiglottis and swollen arytenoids

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Treatment

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  • Endotracheal intubation must be performed immediately in children but not necessarily in adults

  • After an airway is established, cultures of the blood and epiglottis should be obtained

  • Appropriate intravenous antibiotics to cover H influenzae and Streptococcus species (ceftriaxone sodium or an equivalent cephalosporin) should be given

  • Intravenous antibiotics should be continued for 2–3 days, followed by oral antibiotics to complete a 10-day course.

  • Extubation can usually be accomplished in 24–48 hours, when direct inspection shows significant reduction in the size of the epiglottis

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