Acute epiglottitis

Background

• Infection of the epiglottis

Microbiology

• Pediatric
  • Haemophilus influenzae type B, before routine vaccination
• Adult
  • Streptococcus pneumoniae
  • Streptococcus pyogenes
  • Neisseria meningitidis
• Cryptogenic (now most common)

Clinical Manifestations

• In children, presents with fever, irritability, and respiratory distress with or without stridor
  • Often a muffled, hoarse voice
  • Cough is rare
• In adults, presents with odynophagia and sore throat
  • May also have fever, drooling, or stridor

Differential Diagnosis

• Viral croup
• Bacterial tracheitis
• Thermal epiglottitis
• Angioneurotic edema
• Retropharyngeal abscess
• Peritonsillar abscess
• Uvulitis
• Diphtheria

Investigations

• Lateral neck x-ray shows thumb sign
• Laryngoscopy

Management

• Ceftriaxone
• Include Staph aureus coverage if concerned for bacterial tracheitis
• Vanco to cover resistant pneumococcus if common
• 7-10 days