epiglottitis
EPIGLOTTITIS
Epiglottitis is the inflammation of the epiglottis and supraglottic tissues (aryepilottic folds, arytenoid, uvula).
It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children requiring immediate treatment and typically artificial airway placement.
H. influenzae type B is the most common etiologic agent in children.

Assessment

  • Evaluate for presence & severity of airway obstruction based on history & physical examination
    • Patients on “tripod” position are most likely suffering from severe epiglottitis & needs immediate treatment
  • Direct examination of the pharynx in patients whose signs & symptoms are highly suggestive of epiglottitis should be deferred
  • Stabilize airway prior to performing diagnostics

Laboratory Tests

Culture

  • Culture should be performed by obtaining a swab of the epiglottis during the airway stabilization
    • 60-98% reveals H influenzae type b infection
  • Blood cultures should also be obtained once airway has been established

Other Tests

  • Complete blood count may reveal leukocytosis

Imaging

Laryngoscopy

  • Visualization of the posterior pharynx is the best way to confirm the diagnosis
  • The procedure should be performed speedily in a controlled environment [eg an operating room or an intensive care unit (ICU) where intubation may be promptly performed in the event of airway obstruction]
  • Administration of an inhaled anesthetic may allow an expeditious exam of the airway but an expert in intubation should be on stand by
  • A large, cherry-red epiglottis is usually seen
    • Aryepiglottic folds & base of the tongue may also be inflamed
  • An older cooperative child may voluntarily open the mouth wide enough to permit the direct view of the inflamed epiglottis

Radiography

  • If epiglottitis is considered possible, but not probable, the patient may first undergo x-rays of the upper airway
  • The “thumb sign” which results from edema & enlargement of the epiglottis may be seen
    • Absence of the “thumb sign” does not rule out epiglottitis, but it tells the clinician that examination of the pharynx may be done w/o great danger of airway obstruction
  • Other findings indicative of epiglottitis include absence of vallecular air space, thickened aryepiglottic folds, distended hypopharynx & straightening of cervical lordosis

Ultrasonography

  • Ultrasound evaluation in older patients usually shows an “alphabet P sign” due to severely inflamed epiglottis & the hyoid bone
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21 Mar 2018
During the Kuala Lumpur International Neonatology Conference held in conjunction with the World Prematurity Day 2017, Dato Dr Musa Mohd Nordin spoke on the importance of immunizing children with the diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine. He highlighted the role of Hexaxim® as a fully liquid, ready-to-use, 6-in-1 (including hepatitis B) vaccine for the primary and booster vaccinations of infants and toddlers. Meanwhile, Dr Yong Junina Fadzil discussed the benefits of quadrivalent influenza vaccines (QIVs) in providing children with broader protection against influenza B viruses.