Epiglottitis

General Illness Information

Medical Term:
EPIGLOTTITIS

Common Name: None Specified

Description:

Epiglottitis represents a true medical emergency. It is a life-threatening childhood infection of the epiglottis. Epiglottis is the structure that closes the entrance to the voice box and the wind pipe (larynx and trachea ) during swallowing. Epiglottitis is contagious. It can lead to upper airway obstruction.

It is rare under the age of two years, commonest between the age of two and five years, and may occur in adults. Males  and females are affected equally.

Incidence of epiglottitis has decreased dramatically since the introduction of the Hemophilius b vaccine.

Causes:

Infection of the epiglottis by a bacteria (usually Haemophilus influenzae,rarely pneumococcus or Streptococcus). The infection usually begins in the upper respiratory tract as inflammation of the nose and throat. The infection then spreads to the epiglottis. The infection is often associated with bacteria in the blood stream.

Prevention:

  • Immunize children against Hemophilus influenza. H.influenzae vaccine is effective but is not 100% protective.
  • An antibiotic (rifampin) may be prescribed prophylactcally for all household and daycare contacts .Family and close contacts may be asymptomatic carriers of H. influezae.

Signs & Symptoms

  • Very sudden onset and progresses very rapidly.
  • Muffled voice or cry (in croup it is more hoarse).
  • Minimal cough (in croup it is a barking cough).
  • Sore throat.
  • Fever.
  • Hoarseness.
  • Drooling caused by difficulty swallowing saliva.
  • Increasing breathing difficulty with in drawing of intercostal muscles (muscles between the ribs.).
  • Noisy, high-pitched, squeaky inhalations.
  • Purple skin and nails.
  • Odd head posture. The child tilts the neck back and leans forward with the tongue stuck out and the nostrils flared, trying to inhale more air.

Risk Factors

  • Children not immunized against H. influenzae.
  • Illness that has lowered resistance.
  • Crowded or unsanitary living conditions.

Diagnosis & Treatment

  • Epiglottitis is a medical emergency and a child is hospitalized immediately when epiglottitis is suspected. While transporting the child to hospital, have him sitting up.
  • Diagnostic tests include blood cultures, and throat cultures.

General Measures:

  • Do not attempt to look into the child’s throat if you suspect epiglottitis
  • Keep child calm as panic increases breathing difficulty.
  • Hospitalization in the intensive care is necessary where an airway will be inserted and intravenous antibiotics will be started.
  • Intubation is usually required for 24-36 hours.
  • After hospitalization use a cool mist humidifier for 2-3 weeks. Clean the humidifier daily.

Medications:

Antibiotics to control infection. Continue for a minimum of 10 days.

Activity:

Bed rest is necessary until all symptoms disappear. Activities may then be resumed gradually.

Diet:

Fluids only (usually intravenous) until the child can swallow. After hospitalization, encourage extra fluids and provide a normal diet.

Possible Complications :

  • Pneumonia, meningitis, septic arthritis, pericarditis, or cellulitis.
  • Without treatment, complete airway obstruction and death within hours.

Prognosis

With prompt diagnosis and treatment, full recovery is expected.

Other

‘Nothing Specified’.