Tag: Acute Epigottitis

Acute Epigottitis

Acute Epigottitis


ACUTE EPIGLOTTITS

  • It is an acute inflammation of epiglottis with inflammatory edema of hypopharynx.
  • It is a true medical emergency.
  • H.influenzae Influenza Type B  is the most common causative organism.
  • Most cases of epiglottitis and meningitis due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
  • Other organisms are – Pneumococci, Streptococcus pyogenes, N.meningitidis, Staphylococcus.

CLINICAL FEATURES OF EPIGLOTTITIS

  • Onset is sudden
  • Symptoms are fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.
  • Patients often sit in sniffing dog position.

Complications:

  • The main complication is death from respiratory arrest due to acute airway obstruction.
  • Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre’s syndrome)

DIAGNOSIS AND TREATMENT OF EPIGLOTTITIS

  • Laryngoscopy-“Cherry red” swollen epiglottis is seen.
  • Acute Laryngeal Spasm may occur during Indirect Laryngoscopy.
  • Radiograph – Culture of blood and secretions covering Epiglottis
  •  A plain lateral soft tissue radiograph of neck shows the following specific features
  • Thickening of the epiglottis—the thumb sign
  • Absence of a deep well-defined vallecula—the vallecula sign

Treatment

  • Immediate endotracheal intubation.
  • IV antibiotics to cover H.influenzae.
  • The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.
Exam Question
 
  • Most common cause of acute epiglottitis in children is Hemophilus influenzae type B.
  • Thumb sign is seen in Acute epiglottitis.
  • Acute laryngeal spasm during indirect laryngoscopy is seen in Acute epiglottitis.
  • Most cases of invasive disease (epiglottitis, meningitis) due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
  • In acute epiglottitis, common cause of death is Respiratory obstruction.
  • The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.
Don’t Forget to Solve all the previous Year Question asked on Acute Epigottitis

Acute Epigottitis

Acute Epigottitis

Q. 1

Most common cause of acute epiglottitis in children is:

 A Hemophilus influenzae type B
 B

Klebsiella

 C Para influenza virus type I and II
 D

Streptococcus pneumoniae

Q. 1

Most common cause of acute epiglottitis in children is:

 A Hemophilus influenzae type B
 B

Klebsiella

 C Para influenza virus type I and II
 D

Streptococcus pneumoniae

Ans. A

Explanation:

Hemophilus influenzae type B REF: P L Dhingra 4th edition page 266, 399

“Acute epiglottitis in children is caused by Hemophilus influenzae type B. It produces a typical “Thumb sign” on lateral X-ray film. Ampicillin was considered the drug of choice but now many organisms have become resistant to it and ceftriaxone is preferred”

“It is a serious condition and affects children of 2-7 years of age but can also affect adults H. influenzae B is the most common organism responsible for this condition in children”


Q. 2

Thumb sign is seen in __________________

 A

Acute epiglottitis 

 B

Acute laryngo trachea bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Q. 2

Thumb sign is seen in __________________

 A

Acute epiglottitis 

 B

Acute laryngo trachea bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Ans. A

Explanation:

 

DIFFERENCES BETWEEN ACUTE EPIGLOTTITIS AND ACUTE LARYNGO-TRACHEO­BRONCHITIS IN CHILDREN:

 

Acute epiglottitis

Acute laryngo-tracheo-bronchitis (or group)

Causative organism

Haemophilus influenzae type B

Para influenza virus type I and II

Age

2-7 years

3 months to 3 years

Pathology

Supraglottic larynx

Subglottic area

Prodromal symptoms

Absent

Present

Onset

Sudden

Slow

Fever

High

Low grade or no fever

Patient’s look

Toxic

Non-toxic

Cough

Usually absent

Present, (Barking seal-like)

Strider

Present and may be marked

Present

Odynophagia

Present, with drooling of secretions

Usually absent

Radiology

Thumb sign on lateral view

Steeple sign on anteroposterior view of neck

Treatment

Humidified oxygen, third

generation cephalosporin

(ceftriaxone) or amoxicillin

Humidified 0 2 tent, steroids


Q. 3

Acute laryngeal spasm during indirect laryngoscopy is seen in?

 A

Acute epiglottitis

 B

Acute laryngo tracheo bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Q. 3

Acute laryngeal spasm during indirect laryngoscopy is seen in?

 A

Acute epiglottitis

 B

Acute laryngo tracheo bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Ans. A

Explanation:

Q. 4

Most common cause of acute epiglottitis is

 A

Staphylococcus aureus

 B

H influenza

 C

Streptococcus

 D

Pseudomonas

Q. 4

Most common cause of acute epiglottitis is

 A

Staphylococcus aureus

 B

H influenza

 C

Streptococcus

 D

Pseudomonas

Ans. B

Explanation:

Q. 5 “Epiglottitis” is mainly caused by:
 A Streptococcus
 B Staphylococcus
 C Haemophilus
 D Mycoplasma
Q. 5 “Epiglottitis” is mainly caused by:
 A Streptococcus
 B Staphylococcus
 C Haemophilus
 D Mycoplasma
Ans. C

Explanation:

Haemophilus


Q. 6

Epiglottitis is caused by:

 A

H. influenzae

 B

Para influenzae

 C

Streptococcus

 D

Staphylococcus 

Q. 6

Epiglottitis is caused by:

 A

H. influenzae

 B

Para influenzae

 C

Streptococcus

 D

Staphylococcus 

Ans. A

Explanation:

Q. 7

A previously healthy 18-month-old girl is brought to the office with 2 days of irritability, poor appetite, and pulling at her left ear. She has no known allergies, and her temperature is 102.8 F. She is easily consoled by the mother and moves her neck spontaneously without discomfort. There is a clear discharge from the nares. The left tympanic membrane is erythematous, dull, and bulging. Which of the following virulence factors is generally absent in the strains of the causative organism that produce otitis media, compared with those that produce epiglottitis or meningitis?

 A

Beta-Lactamase

 B

IgA protease

 C

Lipopolysaccharide

 D

Polyribitol phosphate

Q. 7

A previously healthy 18-month-old girl is brought to the office with 2 days of irritability, poor appetite, and pulling at her left ear. She has no known allergies, and her temperature is 102.8 F. She is easily consoled by the mother and moves her neck spontaneously without discomfort. There is a clear discharge from the nares. The left tympanic membrane is erythematous, dull, and bulging. Which of the following virulence factors is generally absent in the strains of the causative organism that produce otitis media, compared with those that produce epiglottitis or meningitis?

 A

Beta-Lactamase

 B

IgA protease

 C

Lipopolysaccharide

 D

Polyribitol phosphate

Ans. D

Explanation:

This is most likely a case of Haemophilus influenzae otitis media. 95% of all cases of invasive disease (epiglottitis, meningitis) due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
 
Beta-Lactamase is an important pathogenic feature of Moraxella catarrhalis, which is another important cause of otitis media, but would not be an agent of epiglottitis or meningitis.
 
IgA protease is produced by Streptococcus pneumoniae and Neisseria meningitidis. Both of these cause meningitis, but not as commonly in this age group, and would not be the most common causes of otitis media in this case.
 
Lipopolysaccharide (choice C) is present in all gram-negative bacteria and would not be a distinguishing feature between those that cause otitis media and epiglottitis.
 
Ref: Brooks G.F. (2013). Chapter 18. Haemophilus, Bordetella, Brucella, and Francisella. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg’s Medical Microbiology, 26e.

Q. 8

Which among the following causes ‘thumb sign’ on an X-ray lateral view of the neck?

 A

Acute epiglottitis

 B

Acute laryngo trachea bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Q. 8

Which among the following causes ‘thumb sign’ on an X-ray lateral view of the neck?

 A

Acute epiglottitis

 B

Acute laryngo trachea bronchitis

 C

Acute tonsillitis

 D

Acute laryngitis

Ans. A

Explanation:

Thumb sign is typically seen in acute epiglottitis due to swollen epiglottis.

It is better appreciated in lateral view of neck.

Normally, the epiglottis is quite thin in the anteroposterior (AP) dimension, resembling a little finger, whereas the abnormal, inflamed epiglottis appears shorter and has an increased AP dimension, resembling a thumb.

Acute epiglottitis is usually caused by infection with H influenzae type B.


Q. 9

Disease caused by hemophilus –

 A

Chancroid

 B

Influenza

 C

Acute epiglottitis

 D

a and c

Q. 9

Disease caused by hemophilus –

 A

Chancroid

 B

Influenza

 C

Acute epiglottitis

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Chancroid; ‘c’ i.e., Acute epiglottitis


Q. 10

Which of the following is the aetiological agent most often associated with Epiglottitis in children –

 A

Streptococcus pneumoniae

 B

Haemophilus influenzae type b

 C

Neisseria sp

 D

Moraxella catarrhalis

Q. 10

Which of the following is the aetiological agent most often associated with Epiglottitis in children –

 A

Streptococcus pneumoniae

 B

Haemophilus influenzae type b

 C

Neisseria sp

 D

Moraxella catarrhalis

Ans. B

Explanation:

Ans. is `b’ i.e., Haemophilus influenzae type b

“In published case series, it is almost always caused by Haemophilus influenzae type B”. – CPDT

Epiglottitis

  • It is the inflammation of epiglottis with inflammatory edema of hyopharynx.

o It is a true medical emergency.

o H.influenzae is the most common causative organism.

o Other organisms are —> Pneumococci, Streptococcus pyogenes, N.meningitidis, Staphylococcus

Clinical manifestations

  • Onset is sudden
  • Symptoms are —-> fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.

o Patients often sit in sniffing dog position.

o Respiratory arrest may occur.

Imaging

  • “Cherry red” swollen epiglottis by laryngoscope.

o Radiograph —> “Thumbprint” sign. Treatment

o Immediate endotracheal intubation.

o IV antibiotics to cover H.influenzae.


Q. 11

Epiglottitis in a 2-year-old child occurs most commonly due to infection with:

 A

Influenza virus

 B

Staphylococcus aureus

 C

Haemophilus influenzae 

 D

Respiratory syncytial virus

Q. 11

Epiglottitis in a 2-year-old child occurs most commonly due to infection with:

 A

Influenza virus

 B

Staphylococcus aureus

 C

Haemophilus influenzae 

 D

Respiratory syncytial virus

Ans. C

Explanation:

 

 

Though the introduction of Hib vaccine has reduced the annual incidence of acute epiglottitis but still most of the pediatric cases seen today are due to haemophilus influenzae B. —Harrison 17th/ed p212

In adults it can be caused by group A streptococcus, S. pneumoniae, S. aureus and Klebsiella pneumoniae



Q. 12

A child presents with features of upper respiratory tract infection. On investigation,it is found to have ‘thumbprint sign’. Diag­nosis is:

 A

Acute laryngotracheobronchitis

 B

Acute epiglottitis

 C

Acute laryngeal diphtheria

 D

Laryngomalacia

Q. 12

A child presents with features of upper respiratory tract infection. On investigation,it is found to have ‘thumbprint sign’. Diag­nosis is:

 A

Acute laryngotracheobronchitis

 B

Acute epiglottitis

 C

Acute laryngeal diphtheria

 D

Laryngomalacia

Ans. B

Explanation:

Q. 13

Thumb sign in lateral X-ray of neck seen in: 

 A

Epiglottitis

 B

Internal hemorrhage

 C

Saccular cyst

 D

Ca epiglottis

Q. 13

Thumb sign in lateral X-ray of neck seen in: 

 A

Epiglottitis

 B

Internal hemorrhage

 C

Saccular cyst

 D

Ca epiglottis

Ans. A

Explanation:

 

In epiglottis: A plain lateral soft tissue radiograph of neck shows the following specific features

  • Thickening of the epiglottis—the thumb sign
  • Absence of a deep well-defined vallecula—the vallecula sign

 

Steeple sign i.e. Narrowing of subglottic region is seen in chest X-ray of patients of laryngotracheobronchitis (i.e. croup).



Q. 14

In acute epiglottitis, common cause of death is: 

 A

Acidosis

 B

Respiratory obstruction

 C

Atelactasis

 D

Laryngospasm

Q. 14

In acute epiglottitis, common cause of death is: 

 A

Acidosis

 B

Respiratory obstruction

 C

Atelactasis

 D

Laryngospasm

Ans. B

Explanation:

 

Acute Epiglottitis         

  • Respiratory arrest is more likely in patients with rapidly progressive disease arid occurs within hours of onset of the illness
  • Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre’s syndrome)
  • The main complication is death from respiratory arrest due to acute airway obstruction

Q. 15

The antibiotic of choice in acute epiglottitis pending culture sensitivity report is:

 A

Erythromycin

 B

Rolitetracycline

 C

Doxycycline

 D

Ampicillin

Q. 15

The antibiotic of choice in acute epiglottitis pending culture sensitivity report is:

 A

Erythromycin

 B

Rolitetracycline

 C

Doxycycline

 D

Ampicillin

Ans. D

Explanation:

 

 

  • Ampicillin or third generation cephalosporin are effective against H. influenzae and are given by parenteral route. – Dhingra 5/e, p 308
  • According to Harrison DOC are:

Ampicillin + Sulbactam (Not ampicillin alone)

Cefuroxime

Cefotaxime

Ceftriaxone

  • According to Scott’s Brown 7/ed vol-2 pg-2251

The antibiotics of choice are second and third generation cephalosporin. Ampicillin was often prescribed but resistant H.influenza are now emerging

  • According to Turner 10/e, p 390 

Chloramphenicol is the antibiotic of choice and it should be given intramuscularly or preferably intravenously. Amoxycillin or ampicillin is no longer advised as haemophilus organism are now sufficiently often resistant to make its use inappropi­rate.

 



Q. 16

Drug of choice for treatment of epiglottitis is 

 A

Ceftriaxone

 B

Ampicillin

 C

Chloramphenicol

 D

Clindamycin

Q. 16

Drug of choice for treatment of epiglottitis is 

 A

Ceftriaxone

 B

Ampicillin

 C

Chloramphenicol

 D

Clindamycin

Ans. A

Explanation:

 

Treatment of epiglottitis

  • Once the diagnosis of epiglottitis is made, endotracheal intubation must be performed immediately.
  • After an airway is established, cultures of the blood and epiglottis should be obtained and patient started on appropriate intravenous antibiotics to cover H. influenzae (Ceftriaxone or equivalent cephalosporins).

Third generation cephalosporins are preferred as first line agents because of increasing resistance to ampicillin. Ceftriaxone is the treatment of choice for epiglottitis.

Other antibotic options are :-

  • Ampicillin plus sulbactam
  • Cefuroxime
  • Clindamycin
  • Chloramphenicol
  • Cefotaxime

Intravenous antibiotics should be continued for 2-3 days, followed by oral antibiotics to complete a 10 days course.



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