Bacterial Infections in Childhood: Epiglottitis

Description

The epiglottis is the flap-like cartilage at the base of the tongue that acts as a valve to protect the larynx (voice box) and trachea (windpipe). The epiglottis may become infected, a condition termed Epiglottitis , usually by the common bacterial invaders of the throat and respiratory tree (most prominently Haemophilus influenzae, type B ). Infection inflames and swells the epiglottis, limiting its motion. In young children (usually between 2 and 7 years old, in whom these structures are smaller) and occasionally in older children as well as teens and adults, the swelling can become pronounced enough to block the airway entirely, creating a life-threatening situation.
Although the disease can occur in anyone, it most commonly afflicts children between ages 2 and 5, occurring more often in females than in males and in whites more often than in other races.

Symptoms and Signs

Sore throat; fever; difficult or painful swallowing; hoarseness. In infants and young children: whistling or crowing sounds with breathing; shortness of breath and progressive difficulty with breathing; refusal of food or water; sometimes drooling of saliva (refusal to swallow saliva).

Diagnosis and Treatment

Diagnosis is based on x-ray studies. There is a danger that physical examination may trigger sudden and potentially fatal closing of the throat. During the exam a person with epiglottitis often assumes a posture of leaning forward and stretching the neck out to make breathing easier. Once the doctor has made sure that the airway will stay open, a physical exam, with a laryngoscope , may be done under anaesthesia. The swollen, red epiglottis will be visible.

Antibiotics to eradicate the infection are the mainstay of treatment. Severe difficulty in breathing requires immediate measures to preserve or restore the airway. Sometimes this can mean an emergency tracheostomy (opening of the trachea) in order to insert an endotracheal tube through the neck directly into the windpipe. Hospitalisation for at least a few days usually follows this procedure.
A vaccine against Hemophilus influenzae type b is now also available. In the United States, epiglottitis is becoming a rare disease because of routine immunisation, the first in a series of immunisations against Hemophilus influenzae type b is generally given at about the age 2 months.

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Intelihealth.com, Children's Health Section: http://www.intelihealth.com/
2. The Encycloædia Britannica© Online: http://www.britannica.com/