Acute Epigottitis

ACUTE EPIGLOTTITS
  • It is an acute inflammation of epiglottis with inflammatory edema of hypopharynx.
  • It is a true medical emergency.
  • H.influenzae Influenza Type B is the most common causative organism.
  • Most cases of epiglottitis and meningitis due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
  • Other organisms are - Pneumococci, Streptococcus pyogenes, N.meningitidis, Staphylococcus.
CLINICAL FEATURES OF EPIGLOTTITIS
  • Onset is sudden
  • Symptoms are fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.
  • Patients often sit in sniffing dog position.
  • Complications:
  1. The main complication is death from respiratory arrest due to acute airway obstruction.
  2. Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre's syndrome)
DIAGNOSIS AND TREATMENT OF EPIGLOTTITIS
  • Laryngoscopy-"Cherry red" swollen epiglottis is seen.
  • Acute Laryngeal Spasm may occur during Indirect Laryngoscopy.
  1. Radiograph - Culture of blood and secretions covering Epiglottis
  2. A plain lateral soft tissue radiograph of neck shows the following specific features
  • Thickening of the epiglottis—the thumb sign
  • Absence of a deep well-defined vallecula—the vallecula sign
Treatment
  1. Immediate endotracheal intubation.
  2. IV antibiotics to cover H.influenzae.
  • The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.
Exam Question
  • Most common cause of acute epiglottitis in children is Hemophilus influenzae type B.
  • Thumb sign is seen in Acute epiglottitis.
  • Acute laryngeal spasm during indirect laryngoscopy is seen in Acute epiglottitis.
  • Most cases of invasive disease (epiglottitis, meningitis) due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is 
  • generally not caused by type b organisms.
  • In acute epiglottitis, common cause of death is Respiratory obstruction.
  • The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.

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