Epiglottitis, Pediatric

Basics

Description

  • Inflammation of the epiglottis and surrounding supraglottic region (arytenoid cartilage, aryepiglottic folds, uvula, and posterior tongue), which is potentially life threatening due to progressive airway obstruction
  • Children are at greater risk of upper airway obstruction owing to:
    • Decreased cross-sectional area of the upper airway (resistance is proportional to the inverse of the radius to the fourth power)
    • Loose attachment of mucosal surface and increased vascularity of mucosa allows for edema
    • Dynamic collapse of the airway
  • A precipitous decline in the incidence of childhood epiglottitis since the introduction of the Haemophilus influenzae vaccination has occurred, although vaccine failure may result in rare cases among children who have been immunized
  • In the post-Hib vaccine era, the mean age for this disease has increased, and it is now more commonly seen in adolescents and adults than in toddlers or young school-aged children
  • May occur throughout the year
ALERT

All patients with suspected epiglottitis require intensive monitoring and intervention. Rapid progression of airway obstruction may occur

Etiology

  • Infection:
    • H. influenzae type B
    • Streptococcus pneumoniae
    • Group A β-hemolytic
    • Streptococcus
    • Staphylococcus aureus
    • Moraxella catarrhalis
    • Viruses: HSV, varicella, parainfluenza, SARS-CoV-2 (COVID-19)
    • Less common infections include Klebsiella, Pseudomonas, Candida
  • Caustic: Smoke, steam, chemicals
  • Thermal: Hot foods, liquids, vaping
  • Traumatic: Laryngoscopy, foreign body
  • Posttransplant lymphoproliferative disorder
  • Hereditary angioedema

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