UPPER RESPIRATORY TRACT INFECTIONS: EPIGLOTTITIS
Posted: under Anti-Infectives.
Epiglottitis occurs mainly in children and is a rare form of upper respiratory tract infection in adults. Epiglottitis refers to acute inflammation and edema of the epiglottis and aryepiglottic folds. It can cause airway compromise and death, especially in children over the age of 2 years. Haemophilus influenzae type В is the most common bacterial cause. In adults, Streptococcus pneumoniae, Staphylococcus aureus, and Klebsiella species may also cause epiglottitis.Epiglottitis classically manifests with acute onset of dyspnea, dysphagia, dysphonia, and drooling. Cough is usually not a prominent feature. High fever may also be present. Adults and young children (<10 years) may have less severe symptoms. Physical examination may reveal an erythematous epiglottis. A tongue blade should not be used because it can precipitate total airway obstruction. A lateral neck radiograph may show an enlarged epiglottis (the “thumb sign”). However, even a patient with severe epiglottitis can be present with a normal appearing radiograph. An emergency consultation with an otorhinolaryngologist should be requested, and the diagnosis can be confirmed with laryngoscopy.The most important issue in the treatment of epiglottitis is to secure the airway. In children, it is recommended that intubation be performed to ensure airway patency. Intubation for adults must be decided on an individual basis, and careful observation during the first day is crucial. Antibiotics are required for the treatment of epiglottitis. Antibiotics should cover H. influenzae, S. pneumoniae, S. aureus and Klebsiella species. Appropriate choices of antibiotics include ceftriaxone, cefuroxime, cefotaxime, or ampicillin/sulbactam. Consultation with an infectious diseases physician is recommended.*39/348/5*
