ACUTE EPIGLOTTITIS IN CHILDREN

A severe infection of the epiglottis and surrounding tissues that may be rapidly progressive and fatal because of sudden airway obstruction by the inflamed tissues.

Haemophilus influenzae type B is almost always the pathogen. Very rarely streptococci may be responsible. Infection through the respiratory tract extends downwards to produce a supraglottic cellulitis with marked inflammation.
The inflamed epiglottis mechanically obstructs the airway. The work of breathing increases; resulting CO2 retention and hypoxia may lead to fatal asphyxia within a few hours.

Clinical Features

  • Onset frequently acute
  • Fulminating.
  • Sore throat
  • Hoarseness
  • High fever
  • Dysphagia developing abruptly.
  • Respiratory distress with drooling
  • Tachypnoea
  • Dyspnoea and inspiratory stridor.
  • Child may lean forward and hyperextend the neck.
  • Deep suprasternal, supraclavicular, intercostal and subcostal inspiratory retractions.

Management

A This is an absolute emergency! Speed in treatment is vital.

  • Admit immediately if the diagnosis is suspected.
  • Secure airway immediately (nasotracheal intubation or tracheostomy)
  • Allow the child to remain in the position of comfort.
  • Do not try to examine the throat.
  • Avoid sedatives.
  • Provide careful and skilled nursing care to remove secretions, which may cause obstruction even after intubation.
  • IV chloramphenicol 50–100mg/kg in 4 divided doses in 24 hours.
    Direct visualization of the epiglottis by a designated trained person may reveal a beefy red, stiff, and oedematous epiglottis. An airway should be placed immediately!!
  • Remember that manipulation may initiate sudden fatal airway obstruction.