Epiglottitisin Pediatric Populations
Anycondition or disease that leads to airway obstruction can prove to belife-threatening. However, most pediatric patients possess arecognizable etiology and often respond well to appropriateinterventions after immediate recognition. Epiglottitis is among themany causes of respiratory obstruction. Toddlers and infants exploretheir environment using their mouths, and in the process, theyaspirate foreign bodies. Epiglottitis can have grave implicationshence rapid and careful interventions are necessary to avoid anycomplications. This paper discusses epiglottitis in children, and itincludes the pathophysiology, epidemiology, differential diagnosis,and treatment options available.
Keywords:Epiglottitis, inflammation, respiratory arrest, complications.
Alsoknown as supraglottitis, epiglottitis is as a result of theinflammation of the supraglottic tissue or the epiglottis (Ward &Hisley, 2015). The affected tissues include the arytenoid tissue,aryepiglottic folds, and sometimes the uvula. The main causativemicroorganisms are of bacterial origin, but in some instances, directinjury, thermal trauma, or caustic injury may cause epiglottitis.Haemophilusinfluenzaetype B (Hib) is the primary causative agent, but Streptococcusspecies can also cause the disease (Choby & Hunter, 2015).Children suffering from viral infections may present with the diseasesecondary to a super infection with bacteria (Jariwalla, 2013).
Hiband other causative organisms invade and colonize the pharyngealtissues of healthy children. Their spread occurs through respiratorysecretions resulting from intimate contact. The causative organismsthen enter through the mucosal barrier, invade the blood stream, andcause bacteremia affecting the epiglottis and the surrounding tissues(Ward & Hisley, 2015). Bacteremia can also cause infection toother organs like the lungs, joints, ears, meninges, and even theskin. Noninfectious inflammation of the surrounding tissues mayresult from local trauma or chemical injury including blunt injury tothe neck (Jariwalla, 2013).
Theinfection then leads to acute inflammation of the epiglottisresulting in edema. The edema, in turn, reduces the airway aperturesignificantly. The swelling rapidly spreads to the arytenoids and thearyepiglottic folds leading to the narrowing of the airways (Ward &Hisley, 2015). Airway obstruction, mucus plugging, and aspiration ofsecretions can lead to respiratory arrest.
Historically,children between the ages of 2 to 4 years were the most affected. Theintroduction of the Hib vaccine has significantly reduced theincidence of the disease in the USA (Ward & Hisley, 2015). Theuse of the polysaccharide vaccine and the conjugate vaccine hasconsiderably reduced the number of reported cases of the infection.Epidemiological studies have placed the annual rate at 0.63 per100000 persons (Ward & Hisley, 2015). International incidence ofthe disease varies considerably, with prevalence higher in nationswhich do not have universal immunization programs. In countries withmandatory vaccination programs, the incidences are 0.6 per 100000persons (Choby & Hunter, 2015).
Physicalfindings of the disease include drooling, tripod position, muffledvoice in 54% of the cases, stridor, fever, respiratory distress,cervical adenopathy, hypoxia, mild cough, tachycardia, irritability,and pain on palpation of the larynx (Ward & Hisley, 2015).
DifferentialDiagnosis and Rationale
Croupforms part of the differential diagnosis of the disease. Theprodrome, patient’s age, the level of toxicity, and cough type playa crucial role in differentiating epiglottitis from croup (Ward &Hisley, 2015). Croup affects young children, and its primary cause isof viral origin. Children suffering from croup have a barking coughwhich is less toxic compared to that of epiglottitis (Choby &Hunter, 2015). Bacterial tracheitis also presents with symptomssimilar to those of epiglottitis or severe croup. Other conditions tobe considered include anaphylaxis, caustic ingestion, pneumonia,retropharyngeal abscess, uvulitis, and angioneurotic edema(Jariwalla, 2013).
Laryngoscopyoffers the best results in confirming the diagnosis (Choby &Hunter, 2015). Always secure the airway before using any procedure.Tongue depression using a tongue depressor helps visualize thedisease in some cases. Lab investigations are nonspecific, but theWBC count may be slightly higher. Histologic studies show markedinfiltration with leukocytes and edema (Ward & Hisley, 2015).
Themain aim of is to relieve the airway and eradicate the causativeagent (Ward & Hisley, 2015). A pediatric anesthesiologist or apediatric otolaryngologist, or a pediatric surgeon offers the initialmanagement. Once under control, use of drugs to eliminate thecausative agents may be considered and administration of oxygen tocounter respiratory arrest (Choby & Hunter, 2015). Antibioticsagents used include ceftriaxone, chloramphenicol, cefotaxime,clindamycin, cefuroxime, and rifampin (Ward & Hisley, 2015).Analgesics to relieve pain include acetaminophen and ibuprofen.
Epiglottitisis a life-threatening condition to pediatric populations. Decisiveinterventions can make a big difference between anoxic damage ordeath, and complete recovery. Obtaining good outcomes by use of theavailable therapies should be the principal aim when managing thedisease.
Choby,B., & Hunter, P. (2015). Respiratoryinfections.Leawood, KS: American Academy of Family Physicians.
Jariwalla,G. (2013). Respiratorydiseases.Place of publication not identified: Springer.
Ward,S. L., & Hisley, S. M. (2015). Maternal-childnursing care: optimizing outcomes for mothers, children, andfamilies.Philadelphia: F.A. Davis Co.