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