ACUTE EPIGLOTTITIS

An acute inflammation of the epiglottis, a rare but serious disease of young children. Airway obstruction is always
severe, and intubation or tracheostomy is often needed. It is rare since routine childhood immunisation with Hib vaccine was introduced.

Cause

  • Bacterial infection, commonly Haemophilus influenzae

Clinical features

  • Rapid onset of high fever
  • Typical: ”tripod or sniffing” position, preferring to sit, leaning forward with an open mouth, appears anxious
  • Sore throat, difficulty swallowing, drooling, respiratory distress
  • Stridor and maybe cough
  • Appears critically ill (weak, grunting, crying, drowsy, does not smile, anxious gaze, pallor, cyanosis)
  • Asphyxia leading to quick death

Differential diagnosis

  • Laryngeal cause of stridor e.g. laryngotracheobronchitis

Caution

  • Avoid tongue depression examination as this may cause complete airway blockage and sudden death
  • Do not force child to lie down as it may precipitate airway obstruction

Management

  • Admit and treat as an emergency – intubation or tracheostomy may often be needed
  • Avoid examination or procedures that agitate child as this may worsen symptoms. Avoid IM
    medication
  • Insert IV line and provide IV hydration
  • Ceftriaxone 50 mg/kg once daily for 7-10 days

Prevention

  • Hib vaccine is part of the pentavalent DPT/HepB/Hib vaccine used in routine immunisation of children