Epiglottitis differential diagnosis: Difference between revisions

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==Overview==
==Overview==


 
Epiglottitis must be differentiated from other [[Upper Respiratory Disease|upper]] [[Respiratory disease|respiratory diseases]] and conditions that may cause throat pain and airway obstruction examples:<ref name="pmid19135584" /><ref name="pmid18216359" /> [[Croup]] ([[Laryngotracheobronchitis]]), [[Foreign body]] obstruction, [[Subglottic stenosis]], p[[Pharyngitis|haryngitis]], [[tonsilitis]], [[angioedema]], uvulitis, [[Retropharyngeal abscess|retropharyngeal or peritonsilar abscesses]] and [[bacterial tracheitis]]. For example, although patients with [[croup]] and [[epiglottitis]] both have [[stridor]], in [[epiglottitis]] there is associated [[drooling]] without a [[cough]] whereas in [[croup]] there is cough but no [[drooling]].<ref name="pmid26576182">{{cite journal| author=Lee DR, Lee CH, Won YK, Suh DI, Roh EJ, Lee MH et al.| title=Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea. | journal=Korean J Pediatr | year= 2015 | volume= 58 | issue= 10 | pages= 380-5 | pmid=26576182 | doi=10.3345/kjp.2015.58.10.380 | pmc=4644766 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26576182  }} </ref>
==Differentiating Epiglottitis from other Diseases==
==Differentiating Epiglottitis from other Diseases==


Epiglottitis must be differentiated from other [[Respiratory disease|respiratory diseases]] and conditions that may cause throat pain and airway obstruction:<ref name="pmid19135584">{{cite journal |vauthors=Everard ML |title=Acute bronchiolitis and croup |journal=Pediatr. Clin. North Am. |volume=56 |issue=1 |pages=119–33, x–xi |year=2009 |pmid=19135584 |doi=10.1016/j.pcl.2008.10.007 |url=}}</ref><ref name="pmid18216359">{{cite journal |vauthors=Cherry JD |title=Clinical practice. Croup |journal=N. Engl. J. Med. |volume=358 |issue=4 |pages=384–91 |year=2008 |pmid=18216359 |doi=10.1056/NEJMcp072022 |url=}}</ref>
Epiglottitis must be differentiated from other [[Upper Respiratory Disease|upper]] [[Respiratory disease|respiratory diseases]] and conditions that may cause throat pain and airway obstruction:<ref name="pmid19135584">{{cite journal |vauthors=Everard ML |title=Acute bronchiolitis and croup |journal=Pediatr. Clin. North Am. |volume=56 |issue=1 |pages=119–33, x–xi |year=2009 |pmid=19135584 |doi=10.1016/j.pcl.2008.10.007 |url=}}</ref><ref name="pmid18216359">{{cite journal |vauthors=Cherry JD |title=Clinical practice. Croup |journal=N. Engl. J. Med. |volume=358 |issue=4 |pages=384–91 |year=2008 |pmid=18216359 |doi=10.1056/NEJMcp072022 |url=}}</ref>
*[[Croup]] ([[Laryngotracheobronchitis]])
*[[Croup]] ([[Laryngotracheobronchitis]])
*[[Foreign body]] obstruction
*[[Foreign body]] obstruction
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*[[Retropharyngeal abscess|Retropharyngeal or peritonsilar abscesses]]  
*[[Retropharyngeal abscess|Retropharyngeal or peritonsilar abscesses]]  
*[[Bacterial tracheitis]]
*[[Bacterial tracheitis]]
Some simialrities and differences between these differentials are shown below:<ref name="pmid26818155">{{cite journal| author=Hansen M, Meckler G, Lambert W, Dickinson C, Dickinson K, Guise JM| title=Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services. | journal=Am J Emerg Med | year= 2016 | volume= 34 | issue= 3 | pages= 599-601 | pmid=26818155 | doi=10.1016/j.ajem.2015.12.082 | pmc=4799729 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26818155  }}</ref><ref name="pmid26576182">{{cite journal| author=Lee DR, Lee CH, Won YK, Suh DI, Roh EJ, Lee MH et al.| title=Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea. | journal=Korean J Pediatr | year= 2015 | volume= 58 | issue= 10 | pages= 380-5 | pmid=26576182 | doi=10.3345/kjp.2015.58.10.380 | pmc=4644766 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26576182  }} </ref>


{| class="wikitable"
{| class="wikitable"
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![[Tonsilitis]]
![[Tonsilitis]]
![[Retropharyngeal abscess]]
![[Retropharyngeal abscess]]
![[Subglottic stenosis]]
|-
|-
| rowspan="4" |Presentation
| rowspan="4" |Presentation
|Cough
|[[Cough]]
|✔
|✔
|<small>—</small>
|<small>—</small>
|
| rowspan="4" |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[Abdominal pain|abdominal]] pain, [[nausea]] and [[vomiting]]
|
| rowspan="4" |Barking [[cough]], [[stridor]],
|
 
|
[[fever]], [[chest pain]],
 
[[ear pain]], [[difficulty breathing]], [[headache]], [[dizziness]].
| rowspan="4" |[[Sore throat]], pain on swallowing, [[fever]], [[headache]], [[cough]]
| rowspan="4" |[[Neck pain]], [[stiff neck]], [[torticollis]]
 
[[fever]], [[malaise]], [[stridor]], and barking [[cough]]
| rowspan="4" |Depends on severity. May have respiratory distress at birth, exercise-induced [[dyspnea]],  intermittent [[wheezing]]. Inspiratory [[stridor]]. <ref name="pmid26132943">{{cite journal| author=Nussbaumer-Ochsner Y, Thurnheer R| title=IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 1 | pages= 73 | pmid=26132943 | doi=10.1056/NEJMicm1404785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26132943  }}</ref>
|-
|-
|Stridor
|[[Stridor]]
|✔
|✔
|✔
|✔
|
|
|
|
|-
|-
|Drooling
|[[Drooling]]
|<small>—</small>
|<small>—</small>
|✔
|✔
|
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|-
|-
|
| colspan="2" |Others are [[Hoarseness]], [[Difficulty breathing]], symptoms of the [[common cold]], [[Runny nose]], [[Fever]]
|
|[[Difficulty breathing|Other symptoms include difficulty breathing]], [[Difficulty swallowing|fever, chills, difficulty swallowing]], [[hoarseness]] of voice
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|-
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|Causes
|Causes
|
| colspan="2" |[[Parainfluenza virus]]
|
|[[Hemolysis|H. influenza type b, beta-hemolytic]] [[streptococci]], ''[[Staphylococcus aureus]],'' [[fungi]] and [[viruses]].
|
|[[Group A beta-hemolytic streptococci|Group A beta-hemolytic streptococcus]].
|
|[[Staphylococcus aureus]]
|
|Most common cause is viral including [[adenovirus]], [[rhinovirus]], [[influenza]], [[coronavirus]], and [[respiratory syncytial virus]]. Second most common causes are bacterial; ''[[Group A streptococcal infection|Group A streptococcal bacteria]]'',<ref name="pmid3601520">{{cite journal |author=Putto A |title=Febrile exudative tonsillitis: viral or streptococcal? |journal=[[Pediatrics]] |volume=80 |issue=1 |pages=6–12 |year=1987 |pmid=3601520 |doi= |issn=}}</ref> 
|
|Polymicrobial infection. Mostly; [[Streptococcus pyogenes]], [[Staphylococcus aureus]] and respiratory anaerobes (example; Fusobacteria, [[Prevotella species|Prevotella]], and Veillonella species)<ref name="pmid23520072">{{cite journal| author=Cheng J, Elden L| title=Children with deep space neck infections: our experience with 178 children. | journal=Otolaryngol Head Neck Surg | year= 2013 | volume= 148 | issue= 6 | pages= 1037-42 | pmid=23520072 | doi=10.1177/0194599813482292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23520072  }} </ref><ref name="pmid22481424">{{cite journal| author=Abdel-Haq N, Quezada M, Asmar BI| title=Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus. | journal=Pediatr Infect Dis J | year= 2012 | volume= 31 | issue= 7 | pages= 696-9 | pmid=22481424 | doi=10.1097/INF.0b013e318256fff0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22481424  }} </ref><ref name="pmid18948832">{{cite journal| author=Inman JC, Rowe M, Ghostine M, Fleck T| title=Pediatric neck abscesses: changing organisms and empiric therapies. | journal=Laryngoscope | year= 2008 | volume= 118 | issue= 12 | pages= 2111-4 | pmid=18948832 | doi=10.1097/MLG.0b013e318182a4fb | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18948832  }} </ref><ref name="pmid15573356">{{cite journal| author=Brook I| title=Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. | journal=J Oral Maxillofac Surg | year= 2004 | volume= 62 | issue= 12 | pages= 1545-50 | pmid=15573356 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15573356  }} </ref><ref name="pmid18427007">{{cite journal| author=Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ| title=Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 4 | pages= 408-13 | pmid=18427007 | doi=10.1001/archotol.134.4.408 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18427007  }} </ref><ref name="pmid2235179">{{cite journal| author=Asmar BI| title=Bacteriology of retropharyngeal abscess in children. | journal=Pediatr Infect Dis J | year= 1990 | volume= 9 | issue= 8 | pages= 595-7 | pmid=2235179 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2235179  }} </ref>
|
|Congenital, trauma
|-
|-
|Physical exams findings
|Physical exams findings
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| colspan="2" |Suprasternal and [[intercostal]] [[Indrawing|indrawing,]]<ref name="pmid19445760">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref> Inspiratory [[stridor]]<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>, expiratory [[wheezing]],<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>  [[Sternal]] wall retractions<ref name="pmid194457602">{{cite journal |vauthors=Johnson D |title=Croup |journal=BMJ Clin Evid |volume=2009 |issue= |pages= |year=2009 |pmid=19445760 |pmc=2907784 |doi= |url=}}</ref>
|
|[[Cyanosis]], [[Cervical]] [[lymphadenopathy]], Inflammed [[epiglottis]]
|
|Inflammed [[pharynx]] with or without [[exudate]]
|
|Subglottic narrowing with purulent secretions in the trachea<ref name="pmid6869336">{{cite journal| author=Liston SL, Gehrz RC, Siegel LG, Tilelli J| title=Bacterial tracheitis. | journal=Am J Dis Child | year= 1983 | volume= 137 | issue= 8 | pages= 764-7 | pmid=6869336 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6869336  }} </ref><ref name="pmid7271556">{{cite journal| author=Liston SL, Gehrz RC, Jarvis CW| title=Bacterial tracheitis. | journal=Arch Otolaryngol | year= 1981 | volume= 107 | issue= 9 | pages= 561-4 | pmid=7271556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7271556  }} </ref>
|
|[[Fever]], especially 100°F or higher.<ref name="Tonsillitis">Tonsillitis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm. Accessed May 2nd, 2016.</ref><ref name="urlTonsillitis - NHS Choices">{{cite web |url=http://www.nhs.uk/Conditions/Tonsillitis/Pages/Introduction.aspx |title=Tonsillitis - NHS Choices |format= |work= |accessdate=}}</ref>[[Erythema]], [[edema]] and [[Exudate]] of the [[tonsils]].<ref name="pmid25587367">{{cite journal |vauthors=Stelter K |title=Tonsillitis and sore throat in children |journal=GMS Curr Top Otorhinolaryngol Head Neck Surg |volume=13 |issue= |pages=Doc07 |year=2014 |pmid=25587367 |pmc=4273168 |doi=10.3205/cto000110 |url=}}</ref> cervical [[lymphadenopathy]], [[Dysphonia]].<ref name="urlTonsillitis - Symptoms - NHS Choices">{{cite web |url=http://www.nhs.uk/Conditions/Tonsillitis/Pages/Symptoms.aspx |title=Tonsillitis - Symptoms - NHS Choices |format= |work= |accessdate=}}</ref>
|
|Child may be unable to open the mouth widely. May have enlarged
|
 
[[cervical]] [[lymph nodes]] and neck mass.
|Signs of respiratory distress,  intermittent [[wheezing]]. Inspiratory [[stridor]]. <ref name="pmid26132943" />
|-
|-
|Age commonly affected
|Age commonly affected
|
| colspan="2" |Mainly 6 months and 3 years old
|Mainly 6 months and 3 years old
rarely, adolescents and adults<ref name="pmid8769531">{{cite journal| author=Tong MC, Chu MC, Leighton SE, van Hasselt CA| title=Adult croup. | journal=Chest | year= 1996 | volume= 109 | issue= 6 | pages= 1659-62 | pmid=8769531 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8769531  }}</ref>
rarely, adolescents and adults 
|Used to be mostly found in  
|Used to be mostly found in  


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between the ages of 5 to 24 years.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
between the ages of 5 to 24 years.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
|
|Mostly during the first six years of life
|Primarily affects children  
|Primarily affects children  


between 5 and 15 years old.<ref name="Oroface">{{cite book |last1=Sharav |first1=Yair |last2=Benoliel |first2=Rafael |date=2008 |title=Orofacial Pain and Headache |url= |location= |publisher=Elsevier |page= |isbn=0723434123}}</ref>
between 5 and 15 years old.<ref name="Oroface">{{cite book |last1=Sharav |first1=Yair |last2=Benoliel |first2=Rafael |date=2008 |title=Orofacial Pain and Headache |url= |location= |publisher=Elsevier |page= |isbn=0723434123}}</ref>
|
|Mostly between 2-4 years, but can occur in other age groups.<ref name="pmid12777558">{{cite journal| author=Craig FW, Schunk JE| title=Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. | journal=Pediatrics | year= 2003 | volume= 111 | issue= 6 Pt 1 | pages= 1394-8 | pmid=12777558 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12777558  }}</ref><ref name="pmid1876473">{{cite journal| author=Coulthard M, Isaacs D| title=Neonatal retropharyngeal abscess. | journal=Pediatr Infect Dis J | year= 1991 | volume= 10 | issue= 7 | pages= 547-9 | pmid=1876473 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1876473  }}</ref>
|May be congenital congenital or acquired. Mean age in acquired is 54.1 years<ref name="pmid28007041">{{cite journal| author=Nicolli EA, Carey RM, Farquhar D, Haft S, Alfonso KP, Mirza N| title=Risk factors for adult acquired subglottic stenosis. | journal=J Laryngol Otol | year= 2017 | volume= 131 | issue= 3 | pages= 264-267 | pmid=28007041 | doi=10.1017/S0022215116009798 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28007041  }}</ref>
|-
|-
|Imaging finding
|Imaging finding
|
| colspan="2" |[[Steeple sign]] on neck X-ray
|Steeple sign on neck X-ray
|[[Thumbprint sign]] on neck x-ray
|Thumb print sign on neck x-ray
|<small>—</small>
|
|Lateral neck xray shows intraluminal membranes and tracheal wall irregularity.
|
|Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.<ref name="pmid26527518">{{cite journal| author=Kawabata M, Umakoshi M, Makise T, Miyashita K, Harada M, Nagano H et al.| title=Clinical classification of peritonsillar abscess based on CT and indications for immediate abscess tonsillectomy. | journal=Auris Nasus Larynx | year= 2016 | volume= 43 | issue= 2 | pages= 182-6 | pmid=26527518 | doi=10.1016/j.anl.2015.09.014 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26527518  }} </ref><ref name="pmid25946659">{{cite journal| author=Nogan S, Jandali D, Cipolla M, DeSilva B| title=The use of ultrasound imaging in evaluation of peritonsillar infections. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 11 | pages= 2604-7 | pmid=25946659 | doi=10.1002/lary.25313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25946659  }} </ref><ref name="pmid25945805">{{cite journal| author=Fordham MT, Rock AN, Bandarkar A, Preciado D, Levy M, Cohen J et al.| title=Transcervical ultrasonography in the diagnosis of pediatric peritonsillar abscess. | journal=Laryngoscope | year= 2015 | volume= 125 | issue= 12 | pages= 2799-804 | pmid=25945805 | doi=10.1002/lary.25354 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25945805  }} </ref>
|
|On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen<ref name="pmid15667676">{{cite journal| author=Philpott CM, Selvadurai D, Banerjee AR| title=Paediatric retropharyngeal abscess. | journal=J Laryngol Otol | year= 2004 | volume= 118 | issue= 12 | pages= 919-26 | pmid=15667676 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15667676  }}</ref><ref name="pmid12761699">{{cite journal| author=Vural C, Gungor A, Comerci S| title=Accuracy of computerized tomography in deep neck infections in the pediatric population. | journal=Am J Otolaryngol | year= 2003 | volume= 24 | issue= 3 | pages= 143-8 | pmid=12761699 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12761699  }}</ref>
|
|Bronchoscopy reveals subglottic stenosis. Computed tomography may  reveal a concentric stenotic tracheal segment.<ref name="pmid261329432">{{cite journal| author=Nussbaumer-Ochsner Y, Thurnheer R| title=IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 1 | pages= 73 | pmid=26132943 | doi=10.1056/NEJMicm1404785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26132943  }}</ref>
|-
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|Treatment
|Treatment
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| colspan="2" |[[Dexamethasone]] and nebulised [[epenephrine|epinephrine]]
|
|Airway maintenance, p[[Parenteral|arenteral]] [[Cefotaxime]] or [[Ceftriaxone]] in combination with [[Vancomycin]]. Adjuvant therapy includes [[corticosteroids]] and racemic [[Epinephrine]].<ref name="pmid15983574">{{cite journal| author=Nickas BJ| title=A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy. | journal=J Emerg Nurs | year= 2005 | volume= 31 | issue= 3 | pages= 234-5; quiz 321 | pmid=15983574 | doi=10.1016/j.jen.2004.10.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15983574  }}</ref><ref name="pmid12557859">{{cite journal| author=Wick F, Ballmer PE, Haller A| title=Acute epiglottis in adults. | journal=Swiss Med Wkly | year= 2002 | volume= 132 | issue= 37-38 | pages= 541-7 | pmid=12557859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12557859  }}</ref>
|
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]].
|
|Airway maintenance and antibiotics
|
|[[Antimicrobial]] therapy mainly [[penicillin]]-based and [[analgesics]] with [[tonsilectomy]] in selected cases.
|
|Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin.
|
|Endoscopic balloon dilation  for patients with low-grade subglottic stenosis,<ref name="pmid27095722">{{cite journal| author=Cui PC, Luo JS, Zhao DQ, Guo ZH, Ma RN| title=[Management of subglottic stenosis in children with endoscopic balloon dilation]. | journal=Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi | year= 2016 | volume= 51 | issue= 4 | pages= 286-8 | pmid=27095722 | doi=10.3760/cma.j.issn.1673-0860.2016.04.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27095722  }}</ref> glucocorticoid injections, and resection.<ref name="pmid261329433">{{cite journal| author=Nussbaumer-Ochsner Y, Thurnheer R| title=IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis. | journal=N Engl J Med | year= 2015 | volume= 373 | issue= 1 | pages= 73 | pmid=26132943 | doi=10.1056/NEJMicm1404785 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26132943  }}</ref>
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Primary care]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Pediatrics]]
[[Category:Pulmonology]]

Revision as of 01:30, 21 September 2017

Epiglottitis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Epiglottitis must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction examples:[1][2] Croup (Laryngotracheobronchitis), Foreign body obstruction, Subglottic stenosis, pharyngitis, tonsilitis, angioedema, uvulitis, retropharyngeal or peritonsilar abscesses and bacterial tracheitis. For example, although patients with croup and epiglottitis both have stridor, in epiglottitis there is associated drooling without a cough whereas in croup there is cough but no drooling.[3]

Differentiating Epiglottitis from other Diseases

Epiglottitis must be differentiated from other upper respiratory diseases and conditions that may cause throat pain and airway obstruction:[1][2]

Some simialrities and differences between these differentials are shown below:[4][3]


Variable Croup Epiglottitis Pharyngitis Bacterial tracheitis Tonsilitis Retropharyngeal abscess Subglottic stenosis
Presentation Cough Sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting Barking cough, stridor,

fever, chest pain,

ear pain, difficulty breathing, headache, dizziness.

Sore throat, pain on swallowing, fever, headache, cough Neck pain, stiff neck, torticollis

fever, malaise, stridor, and barking cough

Depends on severity. May have respiratory distress at birth, exercise-induced dyspnea, intermittent wheezing. Inspiratory stridor. [5]
Stridor
Drooling
Others are Hoarseness, Difficulty breathing, symptoms of the common cold, Runny nose, Fever Other symptoms include difficulty breathing, fever, chills, difficulty swallowing, hoarseness of voice
Causes Parainfluenza virus H. influenza type b, beta-hemolytic streptococci, Staphylococcus aureus, fungi and viruses. Group A beta-hemolytic streptococcus. Staphylococcus aureus Most common cause is viral including adenovirus, rhinovirus, influenza, coronavirus, and respiratory syncytial virus. Second most common causes are bacterial; Group A streptococcal bacteria,[6]  Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[7][8][9][10][11][12] Congenital, trauma
Physical exams findings Suprasternal and intercostal indrawing,[13] Inspiratory stridor[14], expiratory wheezing,[14] Sternal wall retractions[15] Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis Inflammed pharynx with or without exudate Subglottic narrowing with purulent secretions in the trachea[16][17] Fever, especially 100°F or higher.[18][19]Erythema, edema and Exudate of the tonsils.[20] cervical lymphadenopathy, Dysphonia.[21] Child may be unable to open the mouth widely. May have enlarged

cervical lymph nodes and neck mass.

Signs of respiratory distress, intermittent wheezing. Inspiratory stridor. [5]
Age commonly affected Mainly 6 months and 3 years old

rarely, adolescents and adults[22]

Used to be mostly found in

pediatric age group between 3 to 5 years,

however, recent trend favors adults

as most commonly affected individuals[23]

with a mean age of 44.94 years.

Mostly in children and young adults,

with 50% of cases identified

between the ages of 5 to 24 years.[24]

Mostly during the first six years of life Primarily affects children

between 5 and 15 years old.[25]

Mostly between 2-4 years, but can occur in other age groups.[26][27] May be congenital congenital or acquired. Mean age in acquired is 54.1 years[28]
Imaging finding Steeple sign on neck X-ray Thumbprint sign on neck x-ray Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. Intraoral or transcutaneous USG may show an abscess making CT scan unnecessary.[29][30][31] On CT scan, a mass impinging on the posterior pharyngeal wall with rim enhancement is seen[32][33] Bronchoscopy reveals subglottic stenosis. Computed tomography may reveal a concentric stenotic tracheal segment.[34]
Treatment Dexamethasone and nebulised epinephrine Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[35][36] Antimicrobial therapy mainly penicillin-based and analgesics. Airway maintenance and antibiotics Antimicrobial therapy mainly penicillin-based and analgesics with tonsilectomy in selected cases. Immediate surgical drainage and antimicrobial therapy. emperic therapy involves; ampicillin-sulbactam or clindamycin. Endoscopic balloon dilation for patients with low-grade subglottic stenosis,[37] glucocorticoid injections, and resection.[38]

References

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  2. 2.0 2.1 Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359.
  3. 3.0 3.1 Lee DR, Lee CH, Won YK, Suh DI, Roh EJ, Lee MH; et al. (2015). "Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea". Korean J Pediatr. 58 (10): 380–5. doi:10.3345/kjp.2015.58.10.380. PMC 4644766. PMID 26576182.
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  34. Nussbaumer-Ochsner Y, Thurnheer R (2015). "IMAGES IN CLINICAL MEDICINE. Subglottic Stenosis". N Engl J Med. 373 (1): 73. doi:10.1056/NEJMicm1404785. PMID 26132943.
  35. Nickas BJ (2005). "A 60-year-old man with stridor, drooling, and "tripoding" following a nasal polypectomy". J Emerg Nurs. 31 (3): 234–5, quiz 321. doi:10.1016/j.jen.2004.10.015. PMID 15983574.
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