What are epiglottitis?

Causes and Symptoms

Epiglottitis is an acute, severe infection that most often affects children between ages two and six. It is most commonly caused by the bacterium Haemophilus influenzae type B, but it can also be caused by other bacteria such as Staphylococcus aureus or Streptococcus pneumoniae, fungi such as Candida albicans, and viruses.

Epiglottitis presents classically with a fever and sore throat
in a young child, who progresses rapidly within a few hours to an inability to eat and drooling, with signs of respiratory obstruction such as stridor (an abnormal high-pitched sound when breathing). The epiglottis is a thin flap of cartilage at the back of the tongue that closes the respiratory tract while swallowing. When it is inflamed, respiratory obstruction results. Drooling can occur, as the child may be unable to swallow his or her own saliva. This is an emergency situation, as the respiratory distress can progress rapidly and become life-threatening within minutes.

It is strongly advised that the mouth and larynx not be examined using a tongue depressor, as this could precipitate a spasm of the epiglottis and exacerbate respiratory distress. Epiglottitis is diagnosed by a clinician through laryngoscopy, with efforts made to secure the airway first. Neck x-rays reveal a characteristic “thumbprint” sign caused by an enlarged epiglottis. A blood culture may reveal the causative organism, and an elevated white blood cell count may be observed.

Treatment and Therapy

In most cases of epiglottitis, hospitalization is required, and the patient is usually admitted to the intensive care unit (ICU). The foremost concern is to secure and maintain the airway as soon as possible. Humidified oxygen, oxygen that has been moistened to help the patient breathe better, is administered. If the airway obstruction is severe enough, a tracheal intubation, in which a plastic tube is inserted into the windpipe through the mouth or nose, may be necessary. If the swelling is too severe to allow for intubation, a cricothyrotomy, or emergency airway puncture, may be needed to secure the airway; this is a less intensive procedure than a conventional tracheotomy, although a tracheotomy may be undertaken in some cases too. Antibiotics, intravenous fluids, and corticosteroids may also be administered to decrease the swelling. With proper and prompt treatment, the prognosis is very good.

Perspective and Prospects

Epiglottitis is an acute inflammation of the epiglottis that should be distinguished from laryngotracheobronchitis or croup. Also, children ingesting hot liquids may present with similar symptoms. The disease must be managed efficiently and in a clinical setting only. Since the causative agent of the disease is infectious, family members must also be screened and treated for the disease. In the United States, the aggressive immunization of children against Haemophilus influenzae type B with the Hib vaccine, starting in the 1980s, has resulted in the near-elimination of the incidence of epiglottitis.

Bibliography

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"Epiglottitis." MedlinePlus, February 2, 2012.

Kasper, Dennis L., et al., eds. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill, 2005.

Rakel, Robert E., ed. Textbook of Family Practice. 6th ed. Philadelphia: W. B. Saunders, 2002.

Rymaruk, Jen. "Epiglottitis." Health Library, March 15, 2013.

Tapley, Donald F., et al., eds. The Columbia University College of Physicians and Surgeons Complete Home Medical Guide. Rev. 3d ed. New York: Crown, 1995.