What is All are false about epiglottitis EXCEPT: and explain in detail?
Ans: b (Seen in elderly using crack cocaine)Ref: Dhingra, 5th ed. pg. 309, Nelson Textbook of Paediatrics, 18th ed. pg. 1763,1764, www.wikipedia.comFirst statement that it is common in infant is a wrong one. Epiglottitis typically affects young children, and is associated with fever, difficulty in swallowing, drooling, hoarseness of voice, and stridor. In the past, Haemophilus influenzae type b was the most commonly identified aetiology of acute epiglottitis. But with the use of the HiB vaccine, invasive disease due to H. influenzae type b in pediatric patients has been reduced by 80-90%.Other agents, such as Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus, now represent a larger portion of paediatric cases of epiglottitis in vaccinated children. In the prevaccine era, the typical patient with epiglottitis due to H. influenza type b was 2 -4yr of age.Cases in adults are most typically seen amongst abusers of crack cocaine and have a more subacute presentation. The diagnosis is often made on clinical grounds, although direct fiberoptic laryngoscopy is frequently performed in a controlled environment in order to visualize and culture the typical edematous "cherry-red" epiglottis and to facilitate placement of an endotracheal tube.Direct visualization in an examination room is not recommended because of the risk of immediate laryn- gospasm and complete airway obstruction. Neck radiographs typically reveal an enlarged oedematous epiglottis called as "thumbprint sign", usually with a dilated hypo pharynx and normal subglottic structures.Laboratory tests characteristically document mild to moderate leukocytosis with a predominance of neu- trophils.Blood cultures are positive in a significant proportion of cases but the statement that it is almost always positive is an ambiguous statement and is unlikely to occur. So can exclude that statement also.Epiglottitis is a medical emergency and warrants immediate treatment with an artificial airway placed under controlled conditions. All patients should receive oxygen en route unless the mask causes excessive agitation. Cultures of blood, epiglottic surface, and, in selected cases, cerebrospinal fluid should be collected after airway stabilization.Ceftriaxone, cefotaxime, or a combination of ampicillin and sulbactam should be given parenterally,depending upon the pending culture and susceptibility reports, because from 10- 40% of H. influenzae type b cases are resistant to ampicillin.