Epiglottitis

Key Features

• 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

Clinical Findings

• 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

Diagnosis

• 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

Treatment

• 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