Acute Epiglottitis
From WebHealth
[edit] Acute Epiglottitis
This is another life threatening respiratory condition, which can occur suddenly in children. It is an acute inflammation of the epiglottis, the structure at the entrance or the upper airway, just behind the tongue. The cause of this condition is an infection with bacteria such as Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus aureus, beta-hemolytic streptococcus or Haemophilus parainfluenzae.
In the last few years an intense vaccination program has almost eradicated Haemophilus influenzae cases, but the others are still around.
Symptoms:
A previously healthy child suddenly gets a high fever, throat pain, a hoarseness and problems swallowing. Breathing gets faster and the child is fighting to get air. This is an emergency like acute croup and requires the call of an emergency response team (call 911) as the hospital environment is needed for this complex problem.
Treatment:
A team consisting of an ENT specialist, an anesthesiologist and a pediatrician is usually required for this problem.
Initially laryngoscopy may be required to inspect, take cultures and immediately place a small nasotracheal intubation tube. In this illustration the clear tube is the nasotracheal intubation tube, the smaller red suction tube is for gastric suction to prevent aspiration pneumonia. If this procedure fails, an immediate tracheotomy (an opening between the skin and the trachea) must be made to place an airway. Close observation in an intensive care unit is important to monitor that no further deterioration occurs. Intravenous antibiotics with a betalactamase resistant antibiotic is given until the final culture report and sensitivity tests are back and the antibiotic can be adjusted.
| Infections overview | Respiratory infection |
References:
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 161.
2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.
3. F Charatan BMJ 2000 Oct 21;321(7267):980.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 43.
5. JR Zunt and CM Marra Neurol Clinics Vol.17, No.4,1999: 675-689.
6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 162.
7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.
8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.
9. DO Freedman et al. Med Clinics N. Amer. Vol.83, No 4 (July 1999): 865-883.
10. SP Fisher-Hoch et al. J Virol 2000 Aug; 74(15): 6777-6783.
11. Mandell: Principles and Practice of Infectious Diseases, 5th ed., © 2000 Churchill Livingstone, Inc.
12. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright © 2000 W. B. Saunders Company
13. PE Sax: Infect DisClinics of N America Vol.15, No 2 (June 2001): 433-455.
14. David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.
