Overview
Definition
A rapidly progressive, life-threatening bacterial infection and inflammation of the epiglottis and supraglottic structures.
Epidemiology
Incidence has dramatically decreased due to the Hib vaccine. Now more common in unimmunized children or adults.
Etiology & Risk Factors
- Haemophilus influenzae type b (Hib) - historically the most common
- Streptococcus pneumoniae, Staphylococcus aureus, Group A Strep
Clinical Symptoms
- The 3 Ds: Dysphagia, Drooling, and Distress
- Acute onset of high fever
- Toxic appearance
- 'Tripod' positioning (leaning forward with neck extended to maximize airway)
- Muffled 'hot potato' voice
Clinical Approach
Diagnosis
- DO NOT attempt to visualize the airway (using a tongue depressor can induce complete airway obstruction/spasm)
- Lateral neck X-ray: 'Thumbprint sign' (enlarged epiglottis)
- Definitive diagnosis via direct laryngoscopy performed in the Operating Room with a secure airway team ready
Management
- SECURE THE AIRWAY (Intubation in a controlled setting, often the OR)
- IV Antibiotics (Ceftriaxone + Vancomycin or Clindamycin to cover MRSA)
Complications
- Complete airway obstruction and asphyxiation
- Death