With appropriate treatment, the risk of death among children with the condition is about one percent and among adults is seven percent.With the use of the Hib vaccine, the number of cases of epiglottitis has decreased by more than 95%. While, historically, young children were mostly affected, it is now more common among older children and adults. In the United States it affects about 1.3 per 100,000 children a year. In adults between 1 and 4 per 100,000 are affected a year. It occurs more commonly in the developing world. In children the risk of death is about 6%; however, if they are intubated early it is less than 1%. Signs and symptoms
Epiglottitis is associated with fever, throat pain, difficulty in swallowing, drooling, hoarseness of voice, and stridor. Onset is typically over a day. The throat itself may appear normal.Stridor is a sign of upper airways obstruction and is a surgical emergency. The child often appears acutely ill, anxious, and will have very quiet shallow breathing often keeping the head held forward and insisting on sitting up in bed. The early symptoms are usually insidious but rapidly progressive, and swelling of the throat may lead to cyanosis and asphyxiation. Causes
Epiglottitis is primarily caused by an acquired bacterial infection of the epiglottis. Historically it was most often caused by Haemophilus influenzae type B, but with the availability of immunization this is no longer the case.
Prevention
An effective vaccine, the Hib vaccine, has been available since the 1980s. The antibiotic rifampicin may also be used to prevent the disease among those who have been exposed to the disease and are at high risk. Management
Airway management
The most important part of treatment involves securing the airway. Epiglottitis may require urgent tracheal intubation to protect the airway. Tracheal intubation can be difficult due to distorted anatomy and profuse secretions. Spontaneous respiration is ideally maintained until tracheal intubation is successful. A surgical airway opening (cricothyrotomy) may be required if intubation is not possible. Medication
Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin is then given. If allergy to penicillins is present, trimethoprim/sulfamethoxazole or clindamycin may be an alternative. Nebulized epinephrine may be useful to improve the situation temporarily. Corticosteroids are also typically used. Evidence for benefit, however, is poor. Prognosis
With appropriate treatment, the risk of death among children with the condition is about one percent and among adults is seven percent.Some people may develop pneumonia, lymphadenopathy, or septic arthritis. Epidemiology
While, historically, young children were mostly affected, it is now more common among older children and adults. Before Hemophilus influenzae (Hib) immunization children of two to four were most commonly affected. With immunization about 1.3 per 100,000 children are affected a year. Notable cases
Bill Bixbys 6-year-old son Christopher died of the condition in 1981.Jeannie Mai spent some time in an ICU with epiglottitis.Sarah Silverman spent a week in the ICU at Cedars Sinai Hospital with epiglottitis.George Washington is thought to have died of epiglottitis.