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.[1]
The introduction of vaccination against Haemophilus influenzae type b into the routine calendar has virtually eliminated it.[2]
Pathogenesis[edit | edit source]
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.[2]
The clinical picture[edit | edit source]
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.[3]
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.[2]
Diagnosis[edit | edit source]
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 :
| Acute epiglottitis | Acute laryngitis[1][3] | |
|---|---|---|
| Avarage age | 3–4 years | 6–36 months |
| The course | hours (6-24 hours) | days (2-3) |
| Prodromes | – | runny nose |
| Cough | –/meek | barking |
| Feeding | No | Yes |
| Mouth | saliva flows out | closed |
| Toxicity | Yes | No |
| Temperature | > 38,5° C | < 38,5 °C |
| Stridor | fine | creaking |
| Voice | weak / quiet | hoarse |
| Recurrences | No | Yes |
Treatment[edit | edit source]
- in pre-hospital therapy, do not traumatize the child, transport it completely at rest, sitting; [2]
- 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. [1]
Prevention[edit | edit source]
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.
References[edit | edit source]
Related Articles[edit | edit source]
References[edit | edit source]
- ↑ a b c TASKER, Robert C. – MCCLURE, Robert J. – ACERINI, Carlo L.. Oxford Handbook od Paediatrics. 1. edition. New York : Oxford University Press, 2008. pp. 295. ISBN 978-0-19-856573-4.
- ↑ a b c d HAVRÁNEK, Jiří: Infekce horních dýchacích cest
- ↑ a b KLIEGMAN, Robert M. – MARCDANTE, Karen J. – JENSON, Hal B.. Nelson Essentials of Pediatrics. 5th edition. Elsevier Saunders, 2006. pp. 497. ISBN 978-0-8089-2325-1.
