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Epiglottitis

Epiglottitis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Acute life-threatening bacterial infection consisting of cellulitis and edema of the epiglottis, aryepiglottic folds, arytenoids, and hypopharynx, resulting in narrowing of the glottic opening and airway obstruction; also known as supraglottitis

Epidemiology

  • Epiglottitis caused by Haemophilus influenzae type B occurs most often between the ages of 1 and 7 years (overall range: infancy to adulthood).
  • Epiglottitis and other invasive disease secondary to H. influenzae type B have been reduced by 99% since the introduction of the conjugate vaccines in 1987 (approved for use at 15 months) and 1990 (approved for use at 2, 4, and 6 months).
  • Nontypeable H. influenzae now appears to be a more common cause of invasive disease than type B.
  • Year-round occurrence
  • All geographic areas
  • Can have secondary cases in households or child care centers
  • May be more frequent in children with sickle cell anemia, asplenia, immunoglobulin defects, or hematologic malignancies (e.g., leukemia)
  • Increasing ratio of adult to pediatric cases

Incidence

  • Incidence of pediatric epiglottitis due to any organism has declined in the postvaccine era (0.3 to 0.7/100,000 per year from 3.47 to 6/100,000 per year).
  • Incidence in adults has remained steady (1 to 4/100,000 per year).

General Prevention

  • Universal immunization with H. influenzae type B capsular polysaccharide conjugate vaccines at 2 and 4 months (potential dose at 6 months, depending on the vaccine), with booster at 12 to 15 months
  • Control measures:
    • Prophylaxis for H. influenzae type B index case and susceptible children in household and child care setting and intimate contacts with the assistance of infection control
    • Rifampin: 20 mg/kg/24 h in single dose for 4 days

Pathophysiology

  • Edema of the supraglottic structures (uvula, aryepiglottic folds, arytenoids, epiglottis, and vocal cords) that reduces the airway aperture
  • Respiratory arrest can be caused by airway obstruction, aspiration of oropharyngeal secretions, or mucous plugging.

Etiology

  • H. influenzae, nontypeable and type B (type B accounted for up to 90% of cases prior to the introduction of H. influenzae type B vaccine)
  • Streptococcus pneumoniae
  • Streptococcus pyogenes (group A β-hemolytic Streptococcus)
  • Staphylococcus aureus
  • Groups C and G β-hemolytic Streptococcus
  • Candida albicans may be an etiologic agent in immunocompromised patients and those receiving prolonged corticosteroid treatment.
  • Pasteurella multocida has been implicated in a few cases after exposure to nasopharyngeal secretions from a cat.
  • Other rare isolates: Moraxella catarrhalis, Klebsiella pneumoniae, Neisseria meningitidis, Pseudomonas species, Histoplasma
  • Bacterial superinfection of viral infections including herpes simplex, parainfluenza, varicella, Epstein-Barr
  • Varicella can cause primary infection or lead to a secondary infection, often with S. pyogenes.
  • Noninfectious etiologies include thermal injuries, trauma, and caustic ingestions.

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Citation

Cabana, Michael D., editor. "Epiglottitis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617227/all/Epiglottitis.
Epiglottitis. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617227/all/Epiglottitis. Accessed April 19, 2019.
Epiglottitis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617227/all/Epiglottitis
Epiglottitis [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617227/all/Epiglottitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Epiglottitis ID - 617227 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617227/all/Epiglottitis PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -