Epiglottitis

Case report:

The family doctor is called acute an urgent home visit to a four year old boy who has developed according to short-term symptoms of rhinitis suddenly violent sore throat, hoarseness and high fever of over 39.5 � C. Additionally, swallowing and breathing difficulties have occurred as well as an increased flow of saliva and quite threatening an inspiratory stridor. Physical examination shows a high respiratory rate with cyanosis, there are deep suprasternal, supraclavicular, and subcostal inspiration intercostal retractions in breathing observed and inspiratory stridor and tracheobronchitische noise. During the inspection of the pharynx has a clearly inflamed pharynx and laryngoscopy results in a highly-red swollen epiglottis, which is covered with dickrahmigem, purulent secretions.

Diagnosis and Etiology:

Acute epiglottitis is almost exclusively caused by Haemophilus influenzae type B, very rarely streptococci may be involved. The frequency of such epiglottitis in children aged two to five years at most, but it can occur at any age in adults. Usually it starts with a nasopharyngitis, the deszendierend then may be followed by inflammation of the epiglottis and the lower tracheobronchial tree. There is often a bacteremia. The inflamed epiglottis laid together with the often extensive inflammatory secretions mechanically the airways so that a respiratory insufficiency may result.

Therapy:

The patient should be immediately admitted to hospital accompanied by a doctor, if the clinical examination suggests a epiglottitis. Based on clinical judgment may be necessary in severe cases, intubation or tracheotomy. Antibiotic therapy should be done with a betalaktamasefesten antibiotic because the mostly detected Haemophilus influenzae bacteria are often resistant to ampicillin. We recommend ampicillin plus sulbactam (UNACID) or amoxicillin plus clavulanic acid (Augmentin) or cephalosporins such as cefuroxime (CEFUROXIME), cefotaxime (Claforan) or ceftriaxone (Rocephin). When evidence of a sensitive Haemophilus influenzae strain also ampicillin (Clamoxyl among others) can be given successfully (BINOTAL among others) or amoxicillin. A prevention of conditions caused by H. influenzae epiglottitis is now possible with the highly-effective Haemophilus B conjugate vaccine (PedvaxHIB), which is available for children over two months.