Acute Epiglottitis - Etiology, Pathology, Clinical Features, Investigations & Treatment
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🗣️ Acute Epiglottitis
Acute epiglottitis is an acute infection of the supraglottis, characterized by inflammation of the supraglottic structures.
⚠️ Acute epiglottitis is a serious medical emergency.
What are the other names of Acute Epiglottitis?
What are the structures of Supraglottis?
Age Group Affected
👉 2 to 8 years of age
⭐ Also seen in adults.
In which season, do we see an increase in cases of Acute epiglottitis?
Why is Acute epiglottitis not seen in newborns?
Etiology of Acute Epiglottitis
- Haemophilus influenzae type B
- Beta-hemolytic streptococcus
- Streptococcus pneumoniae
- Streptococcus milleri
- Staphylococcus aureus
- Escherichia coli
- Klebsiella pneumoniae
- Neisseria
- Haemophilus parainfluenzae
What are the organisms causing Acute Epiglottitis in Immunocompromised Individuals?
What is the most common organism causing Acute Epiglottitis?
What is the most common organism causing Croup?
Pathology of Acute Epiglottitis
1- Severe cellulitis of the epiglottis and aryepiglottic folds
⭐ This produces the typical cherry red epiglottis.
2- Congestion and edema of the mucous membrane
3- Thick and inspissated secretions
4- Obstruction of the laryngeal vestibule, preventing an effective cough and removal of secretions
Clinical Features of Acute Epiglottitis
⭐ Abrupt onset with very rapid progression.
Symptoms of Acute Epiglottitis
- Sore throat
- High grade fever
- Dysphagia
- Odynophagia
- Muffled voice
- Drooling
- Dyspnea
What is the typical voice seen in Acute Epiglottitis? What is the reason behind it?
Which symptom helps in differentiating a case of Acute Epiglottitis from a case of Croup?
How does a case of Acute Epiglottitis present in Adults?
Signs of Acute Epiglottitis
1- Toxic Look
2- Tripod Posture
A characteristic posture adopted by the child to maximize airflow.
Describe the Tripod posture seen in a case of Acute Epiglottitis.
What is the mechanism behind the Tripod posture in Acute Epiglottitis?
3- Other Signs
- Muffled voice
- Drooling of saliva
- Inspiratory stridor
- Nasal flaring
- Retraction of the suprasternal notch, supraclavicular and intercostal spaces
- Decreased air entry on auscultation of the chest
4- Oral Cavity & Oropharynx
- Cherry red, swollen, inflamed epiglottis
- Gross erythema and edema of all supraglottic structures
Why is a throat examination contraindicated in a suspected case of acute epiglottitis?
What are the complications of Acute Epiglottitis?
Investigations of Acute Epiglottitis
1- Flexible Fibreoptic Laryngoscopy
Reveals an erythematous and congested epiglottis, with inflammation of the surrounding supraglottic structures.
2- X-ray Neck (Lateral View)
👉 Thumb Sign
What is Thumb sign on Xray seen in Acute epiglottitis?
3- Throat Swab / Blood Culture
Isolates Haemophilus influenzae type B.
Treatment of Acute Epiglottitis
⚠️ Acute epiglottitis is a medical emergency.
1- Hospitalization
The patient is kept under observation, as there is always an impending danger of airway obstruction.
2- Supportive Treatment
- IV fluids, to combat dehydration
- Oxygen inhalation
- Humidification of air, to liquefy thick secretions
3- Antibiotics (Primary Treatment)
Given intravenously.
What are the first line antibiotics used in treatment of Acute epiglottitis?
4- Systemic Corticosteroids
Given when significant airway compromise is suspected.
How will Systemic Corticosteroids help in treatment of Acute epiglottitis?
Which corticosteroids are usually used in treatment of Acute epiglottitis?
5- Nebulization with Epinephrine
- Used only in patients with significant airway compromise
What is the dosage of Nebulized Epinephrine in treatment of Acute epiglottitis?
6- Intubation or Tracheostomy
Required only if there is airway obstruction.
⭐ Patients respond very well to medical treatment, showing improvement within 24 to 48 hours.
How will you monitor the response to treatment in a case of Acute Epiglottitis?
What is the Differential Diagnosis of Acute Epiglottitis?
What are the differences between Acute Epiglottitis and Croup?
🧠 Viva Pearls
- Acute epiglottitis is an acute infection of the supraglottis and is a serious medical emergency.
- Most common in children aged 2 to 8 years, and more common in winter.
- Cherry red epiglottis is due to severe cellulitis of the epiglottis and aryepiglottic folds.
- Onset is abrupt with rapid progression.
- Tripod sign is the characteristic posture that maximizes airflow by pulling the epiglottis anteriorly.
- Thumb sign is seen on a lateral X-ray of the neck.
- Patients improve within 24 to 48 hours with medical treatment.
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