Define Acute Epiglottitis. Describe its aetiology, clinical features, investigations and management.

Definition

• Acute epiglottitis is a rapidly progressive, life-threatening inflammation of the epiglottis and supraglottic structures that can cause sudden complete airway obstruction.
• It is a true paediatric airway emergency.

Etiology

• Classically Haemophilus influenzae type b (Hib) — now rare where Hib vaccination is routine.
• Other causes — Streptococcus pneumoniae, Staphylococcus aureus, group A streptococcus.

Clinical Features (the Classic Picture)

• Rapid onset (over hours) of high fever and a toxic, ill appearance.
• The '4 D's' — Drooling, Dysphagia, Dysphonia (muffled/'hot-potato' voice), and Distress.
• The child sits upright, leaning forward in the 'tripod' position, with soft inspiratory stridor.
• Notably, there is NO barking cough (unlike croup).

Investigations

• Diagnosis is clinical; if a lateral neck X-ray is done it shows the 'thumb sign' (a swollen epiglottis).
• Definitive visualisation is done only in a controlled setting (theatre) during airway management.

Management

• Secure the airway first — call senior anaesthetic/ENT help; intubation (or tracheostomy) under controlled conditions in theatre.
• IV antibiotics — third-generation cephalosporin (ceftriaxone / cefotaxime).
• Oxygen and supportive care; treat close contacts (rifampicin prophylaxis for Hib).

Croup VS Epiglottitis (must Distinguish)

Key Principle

The priority is a calm child and a secured airway — antibiotics come after the airway is safe.