Acute epiglottitis is rare but serious infection caused by Haemophilus influenzae type B. Prompt recognition and treatment is essential as airway obstruction may develop. Epiglottitis was generally considered a disease of childhood but in the UK it is now more common in adults due to the immunisation programme. The incidence of epiglottitis has decreased since the introduction of the Hib vaccine.

Features

• rapid onset
• high temperature, generally unwell
• stridor
• drooling of saliva
• 'tripod' position: the patient finds it easier to breathe if they are leaning forward and extending their neck in a seated position

Diagnosis is made by direct visualisation (only by senior/airway trained staff, see below). However, x-rays may be done, particularly if there is concern about a foreign body:

• a lateral view in acute epiglottis will show swelling of the epiglottis - the 'thumb sign'
• in contrast, a posterior-anterior view in croup will show subglottic narrowing, commonly called the 'steeple sign'

Image showing a normal epiglottis on the left and an inflamed one on the right. Annotated in blue in the bottom two images. Source: By Med Chaos - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=18169786

Management

• immediate senior involvement, including those able to provide emergency airway support (e.g. anaesthetics, ENT)
  • endotracheal intubation may be necessary to protect the airway
• if suspected do NOT examine the throat due to the risk of acute airway obstruction
  • the diagnosis is made by direct visualisation but this should only be done by senior staff who are able to intubate if necessary
• oxygen
• intravenous antibiotics