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Wednesday, March 2, 2011

ACUTE EPIGLOTTITIS

This is rare but serious disease particularly in young children usually caused by bacterial infection almost always Haemophilus influenzae.

Clinical features
Fever and sore throat are the presenting features. Stridor develops rapidly because of inflammatory swelling of the epiglottis and surrounding submucosa. In acute epiglottis, stridor and cough in the absence of hoarseness help to distinguish it from laryngeal causes of stridor.
Complications
Death from asphyxia may occur rapidly. Attempts to examine the throat using a  tongue depressor or any instrument should be avoided when epiglottis is suspected unless facilities for tracheal intubation or tracheostomy are immediately available because this may precipitate complete respiratory obstruction.
Management
In acute epiglottitis intravenous antibiotic therapy is essential. Amoxycillin/clavulanic acid (Augmentin) 30 mg/kg 8-hourly by slow i.v. injection or infusion of chloramphenicol 50-100 mg/kg daily in divided doses should be given as soon as the diagnosis is confirmed or even suspected. Tracheostomy may be necessary as a life-saving measure if complete obstruction of the upper airways occurs.

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