Epiglottitis

Definition/diagnostic criteria Epiglottitis is a potentially life-threatening condition characterised by inflammation and swelling of the epiglottis, often leading to upper airway obstruction. It primarily results from bacterial infection, with Haemophilus influenzae type b (Hib) historically being the most common causative agent. However, since the introduction of the Hib vaccine, the epidemiology has shifted towards other organisms like Streptococcus pneumoniae and Staphylococcus aureus.

Epidemiology The incidence of epiglottitis has significantly decreased in the UK following the Hib vaccination programme. Presently, it is more commonly observed in adults than in children. The condition remains rare but can affect all age groups, with a slight male predominance.

Diagnosis
Clinical features: Key symptoms include sudden onset of fever, severe sore throat, dysphagia, drooling and muffled voice. Stridor and respiratory distress can also occur, indicating airway compromise. Patients typically present in a sitting position, leaning forward with their neck extended and chin thrust out, known as the “tripod position”.

Investigations: None would be performed in primary care as the patient would be admitted urgently on suspicion of epiglottitis.

• Laryngoscopy: Direct visualisation of the swollen, cherry-red epiglottis is diagnostic. However, it should be performed cautiously and preferably in an operating theatre due to the risk of precipitating complete airway obstruction.
• Blood tests: Elevated white cell count and C-reactive protein levels are commonly observed.
• Microbiology: Blood cultures, and if safely obtainable, cultures from the epiglottis can identify the causative organism.
• Imaging: A lateral neck X-ray can show the classic “thumbprint” sign but is not routinely recommended due to the risk of airway compromise during the procedure.

Treatment Immediate assessment and management of the airway is critical. Oxygen should be administered, and preparations for potential intubation or tracheostomy should be made.

Pharmacological treatment:

• Antibiotics: A third-generation cephalosporin, such as ceftriaxone or cefotaxime, is recommended initially. Antibiotic therapy can be tailored based on culture results.
• Corticosteroids: Dexamethasone may be used to reduce airway swelling.
• Analgaesics: For pain and fever management, paracetamol or ibuprofen can be administered.

Prognosis With prompt recognition and appropriate management, the prognosis of epiglottitis is generally good. However, delays in treatment can lead to airway obstruction, respiratory failure and even death. Long-term complications are rare but can include airway stenosis and abscess formation.