Name = PAGENAME
DiseasesDB = 4360
ICD10 = ICD10|J|05|1|j|00
ICD9 = ICD9|464.3, ICD9|476.1
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.
bacterial infectionof the epiglottis, most often caused by " Haemophilus influenzae" type B, although some cases are attributable to " Streptococcus pneumoniae" or " Streptococcus pyogenes".
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 cyanosisand asphyxiation.fact|date=May 2007 Cases in adults are most typically seen amongst abusers of crack cocaineand have a more subacute presentation. George Washingtonis 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 is confirmed by direct inspection using laryngoscopy, although this may provoke airway spasm. The epiglottis and
arytenoidsare cherry-red and swollen. The most likely differential diagnostic candidates are croup, peritonsillar abscess, and retropharyngeal abscess.
C-spine X-ray, the thumbprint signis 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.]
Epiglottitis requires urgent endotracheal
intubationto protect the airway. Ideally, this should be performed by an experienced anesthesiologistor respiratory therapist, with otolaryngologyback-up in case of failed intubation. If intubation fails, tracheotomyis required.
In addition, patients should be given an
antibioticdrug such as ceftriaxoneor chloramphenicol either alone or in association with penicillin or ampicillin for streptococcal coverage.
Some patients may develop
pneumonia, lymphadenopathyor septic arthritis.
*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
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