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Epiglottitis
Classification and external resources
ICD-10 J05.1
ICD-9 464.3, 476.1
DiseasesDB 4360
eMedicine emerg/169 emerg/375 ped/700
MeSH D004826

Epiglottitis is inflammation of the epiglottis - the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this structure can interfere with breathing and constitutes a medical emergency. The infection can cause the epiglottis to either obstruct or completely close off the windpipe.

With the advent of the Hib vaccine, the incidence has been reduced,[1] but the condition has not been eliminated.[2]

Contents

Cause

Epiglottitis involves bacterial infection of the epiglottis, most often caused by Haemophilus influenzae type B, although some cases are attributable to Streptococcus pneumoniae or Streptococcus pyogenes.

Symptoms

Epiglottitis typically affects children, and is associated with fever, difficulty in swallowing, drooling, hoarseness of voice, and stridor. It is important to note however that since the introduction of the Hemophilus infuenzae vaccination in many Western countries (including the UK), the disease is becoming relatively more common in adults. The child often appears acutely ill, anxious, and has very quiet shallow breathing with the head held forward, insisting on sitting up in bed. The early symptoms are insidious but rapidly progressive, and swelling of the throat may lead to cyanosis and asphyxiation. Cases in adults are most typically seen amongst abusers of crack cocaine and have a more subacute presentation. George Washington is thought to have died of epiglottitis.[3]

Diagnosis

Diagnosis is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates are croup, peritonsillar abscess, and retropharyngeal abscess.

On lateral C-spine X-ray, the thumbprint sign is a finding that suggests the diagnosis of epiglottitis.[4]

Treatment

Epiglottitis requires urgent endotracheal intubation to protect the airway. Ideally, this should be performed by an experienced anesthesiologist, Paramedic, Certified Registered Nurse Anesthetist, or respiratory therapist, with otolaryngology back-up in case of failed intubation. If intubation fails, cricothyroidotomy or tracheotomy is required.

In addition, patients should be given antibiotic such as ceftriaxone or chloramphenicol either alone or in combination with penicillin or ampicillin for streptococcal coverage.

Complications

Some patients may develop pneumonia, lymphadenopathy or septic arthritis.

References

  1. ^ Keyser JS, Derkay CS (1994). "Haemophilus influenzae type B epiglottitis after immunization with HbOC conjugate vaccine". Am J Otolaryngol 15 (6): 436–43. PMID 7872480.  
  2. ^ McEwan J, Giridharan W, Clarke RW, Shears P (April 2003). "Paediatric acute epiglottitis: not a disappearing entity". Int. J. Pediatr. Otorhinolaryngol. 67 (4): 317–21. PMID 12663101. http://linkinghub.elsevier.com/retrieve/pii/S0165587602003932.  
  3. ^ Peter Henriques, He Died as He Lived: The Death of George Washington (Mount Vernon, VA: Mount Vernon Ladies Association, 2000), 27-36.
  4. ^ Jaffe JE. Acute Epiglottits. eMedicine.com. Available at: http://www.emedicine.com/Radio/topic263.htm. Accessed on: December 21, 2006.

External links

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Simple English

Epiglottitis is inflammation of the epiglottis, which is the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway, swelling of this can interfere with breathing and can set up a medical emergency.

Symptoms

Epiglottitis usually happens in children. It can be accompanied with fever, problems swallowing, drooling, and stridor. In children, it must always be considered a medical emergency requiring urgent treatment in an emergency room at a hospital.


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