Epiglottitis

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Epiglottitis

Epiglottitis is inflammation of the epiglottis

Epiglottis

The epiglottis is a flap of elastic cartilage tissue covered with a mucous membrane, attached to the root of the tongue. It projects obliquely upwards behind the tongue and the hyoid bone....
- the flap that sits at the base of the tongue, which keeps food from going into the trachea (windpipe). Due to its place in the airway

Airway

The airways are those parts of the respiratory system through which air flows, to get from the external environment to the alveoli.The airway begins at the mouth or nose, and accesses the vertebrate trachea via the pharynx....
, swelling of this structure can interfere with breathing and constitutes a medical emergency

Medical emergency

A medical emergency is an injury or illness that is Acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves....
. The infection can cause the epiglottis to either obstruct or completely close off the windpipe.

With the advent of the Hib vaccine

Hib vaccine

Haemophilus influenzae type b vaccine is a conjugate vaccine developed for the prevention of invasive disease caused by Haemophilus influenzae type b bacteria....
, the incidence has been reduced, but the condition has not been eliminated.

lottitis involves bacteria

Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
l infection

Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
of the epiglottis, most often caused by Haemophilus influenzae
Haemophilus influenzae

Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Richard Friedrich Johannes Pfeiffer during an influenza pandemic....
type B, although some cases are attributable to Streptococcus pneumoniae
Streptococcus pneumoniae

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, Hemolysis diplococcus aerotolerant anaerobe and a member of the genus Streptococcus....
or Streptococcus pyogenes
Streptococcus pyogenes

'Streptococcus pyogenes' is a coccus gram-positive bacteria that grows in long chains and is the cause of Group A streptococcal infections. S....
.

lottitis typically affects children, and is associated with fever

Fever

Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
, difficulty swallowing

Dysphagia

Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right....
, drooling, and stridor

Stridor

Stridor is a high pitched sound resulting from turbulent air flow in the upper airway. It may be inspiratory, expiratory or present on both inspiration and expiration....
.

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Encyclopedia

Epiglottitis is inflammation of the epiglottis

Epiglottis

Airway

Medical emergency

Hib vaccine

Cause

Epiglottitis involves bacteria

Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
l infection

Infection

Symptoms

Epiglottitis typically affects children, and is associated with fever

Fever

Dysphagia

Stridor

Stridor is a high pitched sound resulting from turbulent air flow in the upper airway. It may be inspiratory, expiratory or present on both inspiration and expiration....
. It is important to note however that since the introduction of the Hemophilus infuenzae vaccination in many Western countries (including the UK), the disease is becoming relatively more common in adults. The child often appears acutely ill, anxious, and has very quiet shallow breathing with the head held forward, insisting on sitting up in bed. The early symptoms are insidious but rapidly progressive, and swelling of the throat may lead to cyanosis

Cyanosis

Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of > 5g/dl deoxygenated hemoglobin in blood vessels near the skin surface....
and asphyxiation. Cases in adults are most typically seen amongst abusers of crack cocaine

Crack cocaine

Crack cocaine, crack or rock is a solid, smokable form of cocaine. It is a freebase form of cocaine that can be made using baking soda or sodium hydroxide, in a process to convert cocaine hydrochloride into methylbenzoylecgonine ....
and have a more subacute presentation. George Washington

George Washington

George Washington was the leader of the Continental Army in the American Revolutionary War and served as the List of Presidents of the United States President of the United States of the United States of Americas ....
is thought to have died of epiglottitis.

Diagnosis

Diagnosis is confirmed by direct inspection using laryngoscopy

Laryngoscope

A laryngoscope is a medical instrument that is used to obtain a view of the vocal folds and the glottis, which is the space between the cords....
, although this may provoke airway spasm. The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates are croup

Croup

Croup is a group of respiratory diseases that often affects infants and children under age 6. It is characterized by a barking cough; a whistling, obstructive sound as the child breathes in; and hoarseness due to obstruction in the region of the larynx....
, peritonsillar abscess

Peritonsillar abscess

Peritonsillar abscess, also called PTA or quinsy, is a recognised complication of tonsillitis and consists of a collection of pus beside the tonsil ....
, and retropharyngeal abscess

Retropharyngeal abscess

A retropharyngeal abscess is an abscess in the tissues in the back of the throat, the retropharyngeal space. It can lead to airway obstruction, a life-threatening emergency....
.

On lateral

Human anatomical terms

Human anatomical terms make up a distinct Scientific classification to describe areas of the body, to provide orientation when describing parts of human anatomy, and to distinguish different movements of the body....
C-spine X-ray

X-ray

X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequency in the range 30 Hertz to 30 Hertz and energies in the range 120 Electron volt to 120 keV....
, the thumbprint sign

Thumbprint sign

In radiology, the thumbprint sign is a finding on a lateral C-spine x-ray that suggests the diagnosis of epiglottitis. The sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radio-opaque than normal on Xray, resembling the distal thumb....
is a finding that suggests the diagnosis of epiglottitis.

Treatment

Epiglottitis requires urgent endotracheal intubation

Intubation

In medicine, intubation refers to the placement of a tube into an external or internal orifice of the body. Although the term can refer to endoscopy procedures, it is most often used to denote tracheal intubation....
to protect the airway. Ideally, this should be performed by an experienced anesthesiologist

Anesthesiologist

An anaesthetist , or anesthesiologist , also "anaesthesiologist," is a physician trained to administer anesthesia and manage the medical care of patients before, during, and after surgery....
, Certified Registered Nurse Anesthetist, or respiratory therapist, with otolaryngology

Otolaryngology

Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders. The full name of the specialty is otolaryngology-head and neck surgery. Practitioners are called otolaryngologists-head and neck surgeons, or sometimes otorhinolaryngologists ....
back-up in case of failed intubation. If intubation fails, tracheotomy

Tracheotomy

Tracheotomy and tracheostomy are surgical procedures on the neck to open a direct airway through an incision in the Vertebrate trachea ....
is required.

In addition, patients should be given an antibiotic

Antibiotic

In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics belong to the group of antimicrobial compounds used to treat infections caused by microorganisms, including fungus and protozoa....
drug

Medication

A pharmaceutical drug, also referred to as medicine or medicament, can be loosely defined as any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease....
such as ceftriaxone

Ceftriaxone

Ceftriaxone is a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrum activity against Gram positive and Gram negative bacteria....
or chloramphenicol either alone or in association with penicillin or ampicillin for streptococcal coverage.

Complications

Some patients may develop pneumonia

Pneumonia

Pneumonia is an Inflammation illness of the lung. Frequently, it is described as lung parenchyma/alveolus inflammation and abnormal alveolar filling with fluid ....
, lymphadenopathy

Lymphadenopathy

Lymphadenopathy is a term meaning "disease of the lymph nodes." It is, however, almost synonymously used with "swollen/enlarged lymph nodes".When the infection is of the lymph nodes themselves, it is called lymphadenitis, but when the infection is of the lymph channels, it is called lymphangitis....
or septic arthritis

Septic arthritis

Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis....
.

External links

Jordana Marinoff, Boston Globe, January 10 2006