# Overview - mostly disease of *adults* due to H influneza B vaccination - most common age 40-50 years - spring time - H flu, h parafinfluenzae, pneumococcus, GAS, S aureus causes - previously was mostly disease of infants - 90% of paeds cases < 2 years old **Hx** - severe [[Sore throat]] - unresponsive to conventional abx - fever in most patients **Exam** - hoarse voice - drooling - painful and difficult swallowing - [[Upper airway obstruction (paeds)|Upper airway obstruction]] - common in children - less severe or absent in adults - low pitched or purring [[Stridor]] **Ix** - XR lateral neck - 85% sensitive - many false positives - CT → usually diagnostic - unfortunately, many adults and most children will not tolerate lying flat - blood culture - WCC ![[Pasted image 20250102160305.png|soft tissue lateral neck XR showing thumb-shaped swelling of Epiglottitis and significant airway narrowing]] ![[Pasted image 20250102160510.png|CT of epiglottitis]] # Management **Severe airway obstruction** - avoid upsetting patient - nebulised adrenaline temporising measure - dexamethasone 0.15mg/kg IV up to 10mg - upright management - secure airway → consider gas induction in theatre by experienced anaesthetist - plan for [[Tracheostomy|FONA]] and [[Airway|difficult airway]] **Abx** - ceftriaxone or cefotaxime - 2g IV for 5 days adults; 25mg/kg up to 1g in children **no severe airway obstruction** - intubation required in 25% of adult cases - observe in ICU/HDU setting