Epiglottitis

Epiglottitis is an acute life-threatening bacterial or viral infection that results in swelling and inflammation of the epiglottis. The epiglottis is an elastic cartilage structure at the root of the tongue that prevents food from entering the windpipe (trachea) when swallowing. This causes breathing problems, including stridor, that can progressively worsen and may, ultimately, lead to airway obstruction. There is so much swelling that air cannot get in or out of the lungs resulting in a medical emergency.

The primary cause of epiglottitis is a bacterial infection which is spread through the upper respiratory tract. The bacteria usually is Haemophilus influenzae type B (HIB). The reason some children develop the disease, while others do not, is not completely understood. Another bacteria that can cause epiglottitis is group A ß-hemolytic streptococci.

The CDC recommends three to four doses of the HIB vaccine. {Primary doses are given at 2 and 4 months of age or at 2, 4, and 6 months of age, based on the brand used by the doctor's office. A booster dose is given by 12 to 15 months of age.

The HIB vaccine protects against this bacteria, therefore decreasing the chance of developing epiglottitis.

• The use of the HIB vaccine has significantly decreased the risk of developing the disease.

• The disease usually occurs in children 2 to 6 years of age, but has also occurred in adults.

• The disease can occur at any time; there is no one season that it is more prevalent.

The symptoms of epiglottitis are similar, regardless of the organism causing the inflammation. The following are the most common symptoms of epiglottitis. However, each child may experience symptoms differently. Symptoms may include:

• Upper respiratory infections. In some children, symptoms of epiglottitis begin with symptoms of an upper respiratory infection.
• Quick onset of a very sore throat
• Fever
• Muffled voice
• No cough
• Cyanosis. Blue skin coloring
• Stridor. A high-pitched sound that is usually noted as the child breathes in (inspiration), although it can also be heard as the child breathes out (expiration).

As the disease worsens, the following symptoms may appear:

• Drooling
• Difficulty breathing
• Unable to talk
• The child sits leaning forward
• The child keeps his or her mouth open

Because of the severity of the disease and the need for immediate intervention, the diagnosis is usually made on physical appearance and a thorough medical history. At this point, if epiglottitis is suspected, the child will immediately be transferred to the hospital. As the disease continues, there is a chance of the child's entire airway becoming occluded (blocked), which can make the child stop breathing.

At the hospital, the following additional tests may be performed to confirm the diagnosis:

• X-ray of the neck. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Blood tests
• Visualization of the airway. Visualization of the airway, under optimal safety conditions by a surgeon in the operating room, may be necessary.
• Blood culture. Test to identify the bacteria
• Throat culture. Test to identify the bacteria

The treatment for epiglottitis requires immediate emergency care to prevent complete airway occlusion. The child's airway will be closely monitored, and, if needed, the child's breathing will be assisted with machines.

Also, intravenous (IV) therapy with antibiotics will be started immediately. This will help treat the infection by the bacteria. Treatment may also include:

• Steroid medication (to reduce airway swelling)
• Intravenous (IV) fluids, until the child can swallow again
• Humidified oxygen
• Breathing tube

How well the child recovers from this disease is related to how quickly treatment begins in the hospital setting. Once the child is being monitored, the airway is safe, and antibiotics are started, the disease usually stops progressing within 24 hours. Complete recovery takes longer and depends on each child's condition.

As mentioned above, epiglottitis caused by the bacteria HIB can be prevented with vaccines that start at the age of 2 months. Epiglottitis caused by other organisms cannot be prevented at this time, but are much less common.

If a child is diagnosed with epiglottitis, the child's family or other close contacts are usually treated with a medication called rifampin, to prevent the disease in those people who might have been exposed.