Definition of Acute epiglottitis

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Acute epiglottitis: A very rapidly progressive infection causing inflammation of the epiglottis (the flap that covers the trachea) and tissues around the epiglottis that may lead to abrupt blockage of the upper airway and death.

The infection is usually caused by bacteria (such as Hemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Streptococci) and is contracted through the respiratory tract. Subsequent downward extension produces what is called cellulitis with marked inflammation of the epiglottis and nearby structures.

The inflamed epiglottis mechanically obstructs the airway; the work of breathing increases, and the retention of carbon dioxide and hypoxia (low oxygen) may result. Clearance of secretions is also impaired. These factors may result in fatal asphyxia within a few hours.

The onset of this disease is typically acute and the course is frequently fulminant. Sore throat, hoarseness, and, frequently, high fever develop abruptly in a previously well child. Dysphagia (trouble swallowing) and respiratory distress characterized by drooling, dyspnea (difficulty breathing), tachypnea (fast breathing), and inspiratory stridor (noisy inspiration) develop rapidly, often causing the child to lean forward and hyperextend the neck to enhance air exchange. the child may appear in severe respiratory distress and appear to be struggling for breath.

The patient should be hospitalized immediately whenever the diagnosis is suspected clinically. Direct visualization of the epiglottis is diagnostic. Visualization of the epiglottis should be done only by designated trained personnel using equipment to establish an airway if necessary. If direct examination of the larynx confirms the diagnosis by revealing a beefy red, stiff, and edematous (swollen) epiglottis, an artificial airway should be placed immediately. The causative organism may then be cultured from the upper respiratory tract and, usually, from the blood.

Epiglottitis caused by H. influenzae type b can be prevented with highly effective Haemophilus influenzae type b (Hib) conjugate vaccines in infants at or before 2 months of age.

Because sudden complete airway obstruction occurs so unpredictably, a continually adequate airway must be secured immediately, preferably by nasotracheal intubation, and specific parenteral antibiotics given. Speed is vital. The nasotracheal tube is usually required until the patient has been stable for 24 to 48 hours (usual total intubation time < 60 h). Alternatively, tracheotomy may be performed. For emergency care of children with epiglottitis, each institution should have a predetermined protocol that involves a pediatrician, otolaryngologist, and anesthesiologist. Skilled nursing care is required because secretions can cause obstruction even after intubation or tracheostomy. Infection and inflammation are effectively controlled with IV antibiotics.