Epiglottitis

1. Epidemiology
   1. Commonly misdiagnosed as croup (20% in some studies)
   2. Average age is older than that seen in Croup (Age 2-5)
2. Definition
   1. Potentially fatal infection of supraglottic tissue
3. Etiology
   1. Group A beta hemolytic Streptococcus
   2. Streptococcus Pneumoniae
   3. Staphylococcus aureus
   4. HaemophilusInfluenzae type B
      1. Previously most common cause of Epiglottitis in children
      2. No longer a common cause in United States (due to Hib Vaccine)
   5. Candida albicans
      1. Immunocompromised patients
   6. Thermal airway Burn Injury
4. Symptoms (Acute onset with rapid progression)
   1. Initial Symptoms
      1. Severe Pharyngitis (82%)
      2. Fever
   2. Mild or subtle Stridor (77%)
      1. "Look worse then they sound" (opposite of Croup)
   3. Shortness of Breath (100%)
   4. Irritability or restlessness (46%)
   5. Dysphagia (64%)
   6. Drooling (41%)
   7. Soft muffled voice or Hoarseness (31%)
5. Diagnosis (Differentiate from Croup)
   1. Absence of cough
   2. Dysphagia (difficult swallowing with Drooling)
   3. Toxic appearance
      1. Classically sitting forward with scared expression in tripod position
6. Labs
   1. Complete Blood Count with Leukocytosis
7. Radiology: Lateral Neck XRay
   1. Thumb shaped epiglottis (swollen supraglottis)
   2. Diminished vallecula
8. Management
   1. Avoid Tongue depressor or other oral instruments
      1. Epiglottis irritation may lead to obstruction
   2. Keep patient calm
   3. Antibiotics to cover bacteria listed above
      1. Third Generation Cephalosporin (e.g. Rocephin)
   4. Controlled intubation by anesthesia or Otolaryngology
      1. Epiglottis inspection under anesthesia (fiery red)
      2. Culture epiglottis if possible
   5. Avoid potentially harmful therapies
      1. Avoid Racemic Epinephrine
      2. Avoid Systemic Steroids
9. References
   1. Cressman (1994) Pediatr Clin North Am, 41(2):265-76
   2. Pappas (1997) Consultant, April 1997:857-67