Case 2

Question 1

A 4-year-old boy presented to casualty department with complaints of dysphagia, fever, drooling, and muffled voice. He is toxic-appearing, drooling, and speaks with a muffled ‘hot potato’ voice. The parents deny trauma or evidence of foreign-body ingestion. The child has not received the vaccines in the first and second years of life.
• What is the most likely diagnosis?

Answer 1

Epiglottitis

Question 2

Epiglottitis

Answer 2

Inflammation, oedema and obstruction of the supraglottic

structures including epiglottis

Question 3

What is the most common organism that causes this condition?

Answer 3

Hemophilus influenzae type b 
Children under 5yrs of age
Chocolate agar (X and V)
Gram - coccobacilli
Satellitism test

Question 4

Clinical manifestations of epiglottitis

Answer 4

• rapidly progressing sore throat with dysphagia
• markedly decreased oral intake
• difficulty in controlling secretions, drooling
• difficulty in breathing, may have stridor
• toxic, in acute distress
• febrile
• in the tripod position

Question 5

What investigations would you perform?

Answer 5

1. Blood culture
2. FBC: leukocytosis with left shift
3. ESR & CRP: elevated
4. Diagnostic imaging: lateral neck radiograph: markedly
   enlarged epiglottis, referred to as a ‘thumbprint sign’ 5. laryngoscopy : direct (rigid or flexible) laryngoscopy can
   be performed. This should be performed in the operating room once the airway has been secured

Question 6

How should the patient be managed?

Answer 6

1. Secure airway and supplemental oxygen
   • Respiratory support (intubation and ventilation) • Tracheostomy (may be performed in an emergency in
   patients who cannot be safely intubated).
2. Intravenous antibiotics ( cefotaxime)

Question 7

How may this infection be prevented?

Answer 7

• Immunoprophylaxis Hib vaccine (conjugate vaccine) • Chemoprophylaxis for unvaccinated, household contacts
aged <48 months (Rifampicin)

Question 8

Currently, the incidence of epiglottitis has decreased

dramatically..?

Answer 8

Vaccine

Now most cases happen in adults (Europe and US)