Epiglottitis

GENERAL PRINCIPLES

• Epiglottitis is a respiratory emergency, as inflammation of the epiglottis can lead to airway obstruction.

• H. influenzae type B, S. pneumoniae, S. aureus, and GABHS are common bacterial causes of epiglottitis, although viral and fungal pathogens may also be implicated.

DIAGNOSIS

Clinical Presentation

Fever, sore throat, odynophagia, drooling, muffled voice, and dysphagia in a patient with a normal oropharyngeal examination should prompt a clinical diagnosis of epiglottitis. Inspiratory stridor is a sign of impending respiratory compromise.

Diagnostic Testing

• Throat and blood cultures are useful in determining the etiology.

• Soft-tissue lateral radiographs of the neck may demonstrate the “thumb print” sign.

• Bedside ultrasound can aid in the diagnosis and show the “alphabet P sign.”

• Definitive diagnosis is made by visualization of the epiglottis with direct laryngoscopy.

TREATMENT

• Airway stabilization is the priority; otolaryngology consultation is recommended in all suspected cases.

• Antimicrobial therapy should include an agent that is active against H. influenzae, such as ceftriaxone 2 g IV qday or cefotaxime 2 g IV q6-8h. Vancomycin or clindamycin should be added if there is concern for MRSA. Glucocorticoids are often also given.