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 | — | ✔ | |||||
| 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,[5] | Polymicrobial infection. Mostly; Streptococcus pyogenes, Staphylococcus aureus and respiratory anaerobes (example; Fusobacteria, Prevotella, and Veillonella species)[6][7][8][9][10][11] | |
| Physical exams findings | Suprasternal and intercostal indrawing,[12] Inspiratory stridor[13], expiratory wheezing,[13] Sternal wall retractions[14] | Cyanosis, Cervical lymphadenopathy, Inflammed epiglottis | Inflammed pharynx with or without exudate | Subglottic narrowing with purulent secretions in the trachea[15][16] | Fever, especially 100°F or higher.[17][18]Erythema, edema and Exudate of the tonsils.[19] cervical lymphadenopathy, Dysphonia.[20] | Child may be unable to open the mouth widely. May have enlarged
cervical lymph nodes and neck mass. | |
| Age commonly affected | Mainly 6 months and 3 years old
rarely, adolescents and adults[21] |
Used to be mostly found in
pediatric age group between 3 to 5 years, however, recent trend favors adults as most commonly affected individuals[22] 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.[23] |
Mostly during the first six years of life | Primarily affects children
between 5 and 15 years old.[24] |
Mostly between 2-4 years, but can occur in other age groups.[25][26] | |
| Imaging finding | Steeple sign on neck X-ray | Thumbprint sign on neck x-ray | Lateral neck xray shows intraluminal membranes and tracheal wall irregularity. | ||||
| Treatment | Dexamethasone and nebulised epinephrine | Airway maintenance, parenteral Cefotaxime or Ceftriaxone in combination with Vancomycin. Adjuvant therapy includes corticosteroids and racemic Epinephrine.[27][28] | Airway maintenance and antibiotics |
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.
- ↑ Cheng J, Elden L (2013). "Children with deep space neck infections: our experience with 178 children". Otolaryngol Head Neck Surg. 148 (6): 1037–42. doi:10.1177/0194599813482292. PMID 23520072.
- ↑ Abdel-Haq N, Quezada M, Asmar BI (2012). "Retropharyngeal abscess in children: the rising incidence of methicillin-resistant Staphylococcus aureus". Pediatr Infect Dis J. 31 (7): 696–9. doi:10.1097/INF.0b013e318256fff0. PMID 22481424.
- ↑ Inman JC, Rowe M, Ghostine M, Fleck T (2008). "Pediatric neck abscesses: changing organisms and empiric therapies". Laryngoscope. 118 (12): 2111–4. doi:10.1097/MLG.0b013e318182a4fb. PMID 18948832.
- ↑ Brook I (2004). "Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses". J Oral Maxillofac Surg. 62 (12): 1545–50. PMID 15573356.
- ↑ Wright CT, Stocks RM, Armstrong DL, Arnold SR, Gould HJ (2008). "Pediatric mediastinitis as a complication of methicillin-resistant Staphylococcus aureus retropharyngeal abscess". Arch Otolaryngol Head Neck Surg. 134 (4): 408–13. doi:10.1001/archotol.134.4.408. PMID 18427007.
- ↑ Asmar BI (1990). "Bacteriology of retropharyngeal abscess in children". Pediatr Infect Dis J. 9 (8): 595–7. PMID 2235179.
- ↑ Johnson D (2009). "Croup". BMJ Clin Evid. 2009. PMC 2907784. PMID 19445760.
- ↑ 13.0 13.1 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.
- ↑ Liston SL, Gehrz RC, Siegel LG, Tilelli J (1983). "Bacterial tracheitis". Am J Dis Child. 137 (8): 764–7. PMID 6869336.
- ↑ Liston SL, Gehrz RC, Jarvis CW (1981). "Bacterial tracheitis". Arch Otolaryngol. 107 (9): 561–4. PMID 7271556.
- ↑ Tonsillitis. Medline Plus. https://www.nlm.nih.gov/medlineplus/ency/article/001043.htm. Accessed May 2nd, 2016.
- ↑ "Tonsillitis - NHS Choices".
- ↑ Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
- ↑ "Tonsillitis - Symptoms - NHS Choices".
- ↑ 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.
- ↑ Craig FW, Schunk JE (2003). "Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management". Pediatrics. 111 (6 Pt 1): 1394–8. PMID 12777558.
- ↑ Coulthard M, Isaacs D (1991). "Neonatal retropharyngeal abscess". Pediatr Infect Dis J. 10 (7): 547–9. PMID 1876473.
- ↑ 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.