epiglottitis

Epiglottitis is a very dangerous infection of the epiglottis (the flap of tissue that closes off the larynx when one swallows - sometimes visible sticking up behind the tongue as a rounded shape) and the area around the voicebox (larynx) with a bacterial germ.

Classically, it was almost always caused by Hemophilus influenzae type B, an aggressive bacterium that used to be responsible for many serious infections in children under the age of five. The vaccine against this germ has essentially wiped out H. influenzae epiglottitis, meningitis, cellulitis and pneumonia, diseases that are now very rare but which used to kill or cripple several thousand children a year. Unfortunately, rare cases of epiglottitis still occur, caused by other bacteria (chiefly Staphylococcus aureus and Streptococcus pneumoniae).

Children with epiglottitis have an illness that early on masquerades as viral croup, but who had progressive symptoms of high fever, drooling, restlessness and reluctance to lie down because of impending respiratory obstruction. It was a nightmare emergency often ending in a race to the operating room to get a breathing tube down into the lungs or a tracheostomy done before the larynx closed up completely. It is now very rare and often caused by other germs when it does occur. Good riddance.

Gone, but not totally forgotten. A child with croup who is worsening, who cannot swallow his saliva and drools, or sits upright and can't tolerate being laid down, or who shows any sign of breathing difficulty when quiet, needs immediate medical attention. The child's breathing will be secured and antibiotics will cure the infection completely in a couple of days.

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