Acute epiglottitis

Acute epiglottitis (MKN-10: J05.1) is a life-threatening swelling of the epiglottis and septicemia caused by Haemophilus influenzae type B. It most commonly affects children aged 1-6 years.

The introduction of vaccination against Haemophilus influenzae type b into the routine calendar has virtually eliminated it.

Pathogenesis
Upper airway obstruction occurs by covering part or all of the laryngeal entrance with an epiglottis magnified several times. The cause is the rapidly advancing phlegmon epiglottis. A significant predisposition to these invasive microbes is the reduced ability to produce IgG 2 (protection against invasive encapsulated bacteria), which is physiological at this age.

The clinical picture
Acute epiglottitis has a rapid development (in the order of hours). It starts with a sharp sore throat and difficulty swallowing, then dyspnoea appears. The child is pale, hypoxic, sitting in a forward bend, saliva flowing from his mouth because they cannot drain through the valecules along the epiglottis. The child has a fever, a quiet voice and can cough carefully, superficially.

The physical finding in the lungs is poor, the progression of obstruction, ie dysphagia and dyspnoea coming within a few hours. Rarely, paratonsillar / retropharyngeal abscess, severe pablan tonsillitis may have a similar effect.

Diagnosis
Accurate diagnosis is based on a good aspect of the epiglottis. We perform a gentle aspect of the pharynx after a short pressing of the tongue with a spatula. Enlarged, reddish and soaked epiglottis, often of bizarre shape, appears. Sometimes the epiglottis is not visible, as saliva and inflammatory secretion stagnate in the area, creating a characteristic "pond". In a typical course, the diagnosis can be made on the basis of a clinical finding, independent of the aspect of the epiglottis.

The key is to be able to readily distinguish between acute epiglottitis and laryngitis :

Treatment

 * in pre-hospital therapy, do not traumatize the child, transport it completely at rest, sitting;
 * endotracheal intubation;
 * hospitalization in the ICU;
 * blood culture collection;
 * iv ATB: 2nd or 3rd generation cephalosporins (cefuroxime, ceftriaxone, cefotaxime) 7-10 days.
 * rifampicin should be given as a precaution to persons who come into contact with the child's disability.

Prevention
Regular vaccination against diphtheria, tetanus, whooping cough, hepatitis B virus, polio and Haemophilus influenzae type b (since 2007 as a hexavaccine).

Polyribosylribitol phosphate conjugated to tetanus or genetically modified diphtheria toxoid is used.

Related Articles

 * Acute obstructive laryngitis
 * Upper respiratory tract infection