Epiglottitis differential diagnosis
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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
Differentiating Epiglottitis from other Diseases
Epiglottitis must be differentiated from other respiratory diseases and conditions that may cause throat pain and airway obstruction:[1][2]
- Croup (Laryngotracheobronchitis)
- Foreign body obstruction
- Subglottic stenosis
- Pharyngitis
- Tonsilitis
- Angioedema
- Uvulitis
- Retropharyngeal or peritonsilar abscesses
- Bacterial tracheitis
Some simialrities and differences between these differentials are shown below:[3][4]
| Variable | Croup | Epiglottitis | Pharyngitis | Bacterial tracheitis | Tonsilitis | Retropharyngeal abscess | |
|---|---|---|---|---|---|---|---|
| Presentation | Cough | ✔ | — | sore throat, pain on swallowing, fever, headache, abdominal pain, nausea and vomiting | barking cough, stridor, | sore throat, pain on swallowing, fever, headache, cough | neck pain, stiff neck, torticollis |
| Stridor | ✔ | ✔ | |||||
| Drooling | — | ✔ | |||||
| 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,[5] | Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species) | |
| Physical exams findings | Suprasternal and intercostal indrawing,[6] Inspiratory stridor[7], expiratory wheezing,[7] Sternal wall retractions[8] | Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis | and may have enlarged | ||||
| Age commonly affected | Mainly 6 months and 3 years old
rarely, adolescents and adults[9] |
Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[10] 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.[11] |
Primarily affects children
between 5 and 15 years old.[12] |
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| Imaging finding | Steeple sign on neck X-ray | Thumbprint sign on neck x-ray | |||||
| Treatment | Dexamethasone and nebulised epinephrine | Parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[13][14] | |||||
References
- ↑ Everard ML (2009). "Acute bronchiolitis and croup". Pediatr. Clin. North Am. 56 (1): 119–33, x–xi. doi:10.1016/j.pcl.2008.10.007. PMID 19135584.
- ↑ Cherry JD (2008). "Clinical practice. Croup". N. Engl. J. Med. 358 (4): 384–91. doi:10.1056/NEJMcp072022. PMID 18216359.
- ↑ Hansen M, Meckler G, Lambert W, Dickinson C, Dickinson K, Guise JM (2016). "Paramedic assessment and treatment of upper airway obstruction in pediatric patients: an exploratory analysis by the Children's Safety Initiative-Emergency Medical Services". Am J Emerg Med. 34 (3): 599–601. doi:10.1016/j.ajem.2015.12.082. PMC 4799729. PMID 26818155.
- ↑ 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.
- ↑ Putto A (1987). "Febrile exudative tonsillitis: viral or streptococcal?". Pediatrics. 80 (1): 6–12. PMID 3601520.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ 7.0 7.1 Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ Tong MC, Chu MC, Leighton SE, van Hasselt CA (1996). "Adult croup". Chest. 109 (6): 1659–62. PMID 8769531.
- ↑ Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Sharav, Yair; Benoliel, Rafael (2008). Orofacial Pain and Headache. Elsevier. ISBN 0723434123.
- ↑ 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.
- ↑ Wick F, Ballmer PE, Haller A (2002). "Acute epiglottis in adults". Swiss Med Wkly. 132 (37–38): 541–7. PMID 12557859.