Infectious Disease Compendium

Epiglottitis

Diagnosis

Fevers, chills, sore throat, hoarse (hot potato/potatoe voice), increasing problems with handling their secretions. On the later neck film you will see the 'thumbprint' sign, where the epiglottitis looks like your thumb.

Epidemiologic Risks

Used to be a disease of children, fading thanks to the conjugate H. influenza b vaccine; expect to see the disease in groups of people that are dumb as a box of rocks and do not vaccinate their children. It is always a shame to see a child die due to parents stupidity. At least the genetic buck stops there.

Microbiology

H. influenza. Occasionally S. aureus, and various streptococci including the pneumococcus.

Empiric Therapy

Third generation cephalosporins > a quinolone in the adult. This is an adult guide.

Pearls

If the patient with H. influenzae epiglottitis has unvaccinated household members less than 4 years, give rifampin prophylaxis once daily x 4 days in a dose of 20 mg/kg/day, regardless of immunization status. The patient should also receive rifampin to eliminate carriage and to prevent reintroduction of the organism into the household.

Rants

It is considered poor form to look down the throat of a patient with suspected epiglottitis without a tracheostomy kit at the bedside as looking with a tongue blade can induce obstruction. There are them that poo poo this concept based on low incidence in the literature, but having seen it twice in my career, I remain a wee bit leery.

ICD9 Codes (Soon to be supplanted by ICD10)

Epiglottitis (acute) 464.30; with obstruction 464.31; chronic 476.1; viral 464.30.