Epiglottitis (Uncommon)

Acute epiglottitis (supraglottitis) is a life-threatening infection of the epiglottis and surrounding structures. Since widespread Hib vaccination, epiglottitis has become rare in children (and is rare in adults too). When it does occur, Streptococcus pneumoniae is now the most common pathogen.

Clinical features

Fever; a soft voice; lack of a harsh cough (a key differentiator from croup); preference to sit quietly rather than lie down; soft stridor with a sonorous expiratory component. The child typically sits still with mouth open, drooling, eyes following you around the room (limited head movement protects the compromised airway).

Differentiating from croup

See also croup — the main differential. Croup has a harsh inspiratory stridor, hoarse voice and brassy cough; epiglottitis has a soft voice, soft stridor, and no harsh cough.

Management

Urgent escorted transfer to hospital with airway management — these children often have sepsis or septic shock.

• Intensive monitoring; early ENT/otolaryngology referral.
• IV antibiotics (7–10 days total, IV then oral): ceftriaxone, cefotaxime or moxifloxacin IV; oral switch to augmentin, cefuroxime or moxifloxacin.
• IV dexamethasone — controversial, but commonly given in practice.