Epiglottitis

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 4360
ICD10 = ICD10|J|05|1|j|00
ICD9 = ICD9|464.3, ICD9|476.1
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = emerg
eMedicineTopic = 169
eMedicine_mult = eMedicine2|emerg|375 eMedicine2|ped|700
MeshID = D004826

Epiglottitis is inflammation of the epiglottis - 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, swelling of this structure can interfere with breathing and constitutes a medical emergency. The infection can cause the epiglottis to either obstruct or completely close off the windpipe.

Cause

Epiglottitis involves bacterial infection of the epiglottis, most often caused by "Haemophilus influenzae" type B, although some cases are attributable to "Streptococcus pneumoniae" or "Streptococcus pyogenes".

ymptoms

Epiglottitis typically affects children, and is associated with fever, difficulty swallowing, drooling, and stridor. 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 and asphyxiation.fact|date=May 2007 Cases in adults are most typically seen amongst abusers of crack cocaine and have a more subacute presentation. George Washington is thought to have died of epiglottitis. [Peter Henriques, "He Died as He Lived: The Death of George Washington" (Mount Vernon, VA: Mount Vernon Ladies Association, 2000), 27-36.]

Diagnosis

Diagnosis is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. The epiglottis and arytenoids are cherry-red and swollen. The most likely differential diagnostic candidates are croup, peritonsillar abscess, and retropharyngeal abscess.

On lateral C-spine X-ray, the thumbprint sign is a finding that suggests the diagnosis of epiglottitis. [Jaffe JE. Acute Epiglottits. eMedicine.com. Available at: [http://www.emedicine.com/Radio/topic263.htm http://www.emedicine.com/Radio/topic263.htm] . Accessed on: December 21 2006.]

Treatment

Epiglottitis requires urgent endotracheal intubation to protect the airway. Ideally, this should be performed by an experienced anesthesiologist or respiratory therapist, with otolaryngology back-up in case of failed intubation. If intubation fails, tracheotomy is required.

In addition, patients should be given an antibiotic drug such as ceftriaxone or chloramphenicol either alone or in association with penicillin or ampicillin for streptococcal coverage.

Complications

Some patients may develop pneumonia, lymphadenopathy or septic arthritis.

References

External links

*Jordana Marinoff, [http://www.boston.com/yourlife/health/other/articles/2006/01/10/bacteria_grab_a_windpipe_and_hold_it_hostage "Bacteria Grab a Windpipe and Hold it Hostage,"] Boston Globe, January 10 2006