Acute Epiglottitis
Acute Epiglottitis is an infection caused by certain bacteria to the epiglottis, which is the flap over the windpipe. Enlargement of the epiglottis can obstruct the airway, resulting in a potentially fatal condition.
- Sore throat accompanied by fever, occurring suddenly in a healthy child, is the first sign of epiglottitis. Difficulty in swallowing food and breathing, anxiety, confusion, and irritability, are the other common symptoms.
- The typical symptoms, and an x-ray showing the enlargement of epiglottis, help diagnose the disease.
- Certain bacteria are responsible for epiglottitis.
- Vaccination against the bacteria causing epiglottitis can protect the children from this disease.
- Children with epiglottitis require hospitalization, as the treatment involves keeping the airway open to facilitate breathing, in addition to the antibiotic therapy to overcome the infection.
Epiglottis covers the opening of the larynx and the trachea when the food is being swallowed, thus preventing the entry of the food particles into the airway. This flap of tissue can get infected by certain common bacteria such as Haemophilus influenzae type b, as well as certain strains of staphylococci and streptococci. Before the vaccine against Haemophilus influenzae type b became routine, epiglottitis was prevalent in children in the age group 2 to 5 years. If the affected children have bacteremia or presence of bacteria in their blood, the infection can affect other parts of the body such as the lungs, the meninges enveloping the brain, the pericardium enclosing the heart and tissues under the skin and in the joints.
In adults, different strains of staphylococci and streptococci bacteria, including Streptococcus pneumoniae are responsible for the infection.
Symptoms
Acute Epiglottitis often appears suddenly as a sore throat accompanied by high fever in a child who was previously healthy. Irritability and anxiety are often present. The child’s condition deteriorates fast with the rapid progress of the disease. Difficulty in breathing, and swallowing food, develops, leading to drooling and rapid breathing. The child may lean forward and stretch the neck backward in an attempt to increase the air flow into the lungs. Inhalation is accompanied by a characteristic loud noise called stridor. The blood oxygen levels decrease and carbon dioxide builds up in the blood. This causes symptoms such as confusion, anxiety, and, later on, lethargy. Because of the enlargement of epiglottis, the child cannot cough up the mucus. The swelling narrows the airway, and may even completely block it, cutting off breathing. Without immediate medical intervention, epiglottitis may cause death.
Diagnosis
Acute Epiglottitis is a potentially fatal condition, and it is treated as a medical emergency. When the doctor suspects epiglottitis, the child is immediately hospitalized, and the treatment is initiated as soon as possible. Examining the tongue with a tongue- depressor is avoided, as it may trigger throat spasms which can cause complete blockage and impede breathing. If the child does not seem very ill, and some of the typical symptoms of the disease are absent, the doctor may take an x-ray to check for the enlargement of epiglottis and confirm the diagnosis.
If the child is very ill, and the x-ray shows enlargement of the epiglottis, the child may be examined with a laryngoscope after administering anesthesia. This flexible viewing tube helps the doctor observe the larynx directly.
Prevention
Preventing epiglottitis through vaccination is better than treating the disease. Conjugate vaccines against the bacteria Haemophilus influenzae type b as well as Streptococcus pneumoniae are effective, and help prevent this potentially fatal condition.
Treatment
During physical examination, if epiglottitis is detected, or if the procedure causes throat spasm in the child, an endotracheal tube is introduced into the trachea to keep the airway open. In some cases, the endotracheal tube cannot be inserted into the tracheal tube due to severe swelling of the epiglottis. A surgical procedure called tracheostomy may be necessary in such cases. A small cut is made in the front part of the neck and the tracheal wall to insert the tube, which remains in place till the swelling subsides. Once the airway is free, the child is out of danger. Antibiotics therapy using drugs such as ampicillin-sulbactam or ceftriaxone can eliminate the infection.
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Yasser Elnahas
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