Epiglottitis

Causes and Risks:
Epiglottitis affects one out of 10,000 people. The incidence has been decreasing since the inclusion of HiB as a routine childhood immunization (Haemophilus influenzae group B vaccine). It is most common in children between 2 and 6 years old and is usually caused by the bacterium Hemophilus influenzae, although it may be caused by other bacteria or viruses. It results in the rapid swelling of the epiglottis (the flap of cartilage at the back of the tongue that closes off the windpipe when swallowing) and can obstruct breathing. Immunosuppression (from medications or diseases that reduce the action of the immune system) can predispose adults to epiglottitis.

Epiglottitis is a life threatening disease. It begins with a high fever and very sore throat . Respiratory distress increases rapidly as the epiglottis swells. Swallowing problems are associated with drooling and the patient sits up leaning slightly forward and looking very anxious. Spasm may cause the airway to close abruptly and death follows within minutes. Because of this no attempts should be made to look in the mouth if epiglottitis is suspected. Immediate emergency medical help is imperative. Epiglottitis is always a medical emergency.

Prevention:
The bacteria that causes epiglottitis is contagious, so family members should be screened and treated if appropriate.

Symptoms:



Signs and Tests:
Examination of the larynx ( laryngoscopy ) may show enlarged, reddened epiglottis. Do not attempt to examine the larynx at home, because use of the tongue blade may cause the condition to worsen. An anesthesiologist may need to examine the larynx in a person with epiglottitis, in the event insertion of a tube into the larynx (intubation) becomes necessary to maintain the airway.



Treatment:
Hospitalization is required since this is an emergency situation. The patient is usually admitted to the intensive care unit.

Humidified oxygen is given. Intubation is almost always done so breathing can be maintained. In this procedure, a tube is passed through the nose or mouth into the trachea (the airway to the lungs). Mechanical ventilation (ventilator) usually is not required. Intravenous fluids are given to increase hydration. Antibiotics are used to treat the infection. Corticosteroids may be used to decrease the swelling .

Prognosis:
The probable outcome is good with prompt treatment. If untreated, epiglottitis can be life threatening.

Complications:
Total obstruction of the airway may occur.

Call Your Healthcare Provider:
Go to the emergency room or call the local emergency number (such as 911) if your child has symptoms suggestive of epiglottitis, including breathing difficulties or sudden onset of blue skin color.


This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Courtesy of the Centers for Disease Control.)



A cross-section illustration of the mouth, nasal cavity, and throat. The nasal passages are also visible.



This is a gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenza, one of the most common causes of childhood meningitis (prior to the widespread use of the H. influenza vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenza (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4 and 12 months.