A 4-year-old boy presented to casualty department with complaints of dysphagia, fever, drooling, and muffled voice. He is toxic-appearing, drooling, and speaks with a muffled ‘hot potato’ voice. The parents deny trauma or evidence of foreign-body ingestion. The child has not received the vaccines in the first and second years of life.
• What is the most likely diagnosis?
Epiglottitis
Epiglottitis
Inflammation, oedema and obstruction of the supraglottic
structures including epiglottis
What is the most common organism that causes this condition?
Hemophilus influenzae type b Children under 5yrs of age Chocolate agar (X and V) Gram - coccobacilli Satellitism test
Clinical manifestations of epiglottitis
- rapidly progressing sore throat with dysphagia
- markedly decreased oral intake
- difficulty in controlling secretions, drooling
- difficulty in breathing, may have stridor
- toxic, in acute distress
- febrile
- in the tripod position
What investigations would you perform?
- Blood culture
- FBC: leukocytosis with left shift
- ESR & CRP: elevated
- Diagnostic imaging: lateral neck radiograph: markedly
enlarged epiglottis, referred to as a ‘thumbprint sign’ 5. laryngoscopy : direct (rigid or flexible) laryngoscopy can
be performed. This should be performed in the operating room once the airway has been secured
How should the patient be managed?
- Secure airway and supplemental oxygen
• Respiratory support (intubation and ventilation) • Tracheostomy (may be performed in an emergency in
patients who cannot be safely intubated). - Intravenous antibiotics ( cefotaxime)
How may this infection be prevented?
• Immunoprophylaxis Hib vaccine (conjugate vaccine) • Chemoprophylaxis for unvaccinated, household contacts
aged <48 months (Rifampicin)
Currently, the incidence of epiglottitis has decreased
dramatically..?
Vaccine
Now most cases happen in adults (Europe and US)
