Pseudo Croup & Acute Epiglottitis Notes (Year 2)

## **Pseudo croup / Acute Epiglottitis** Date: 6 Nov 24 ### Definition - **Pseudo croup** is an inflammation of the epiglottis and/or surrounding structures, such as the arytenoids, aryepiglottic folds, and vallecula. - **Epiglottitis** is a life-threatening infection that causes swelling of the e...

## **Pseudo croup / Acute Epiglottitis** Date: 6 Nov 24 ### Definition - **Pseudo croup** is an inflammation of the epiglottis and/or surrounding structures, such as the arytenoids, aryepiglottic folds, and vallecula. - **Epiglottitis** is a life-threatening infection that causes swelling of the epiglottis, obstructing the airway and leading to asphyxia and respiratory failure. ### Symptoms - **Pseudo croup:** - Mild breathing difficulties - Stridor (high-pitched breathing sound) - Barking cough - Hoarseness - Fever - Runny nose - Swollen lymph nodes - **Epiglottitis:** - Severe breathing difficulties - Drooling - Fever - Difficulty swallowing (dysphagia) - Painful swallowing (odynophagia) - Tripod position (leaning forward with head tilted back and chin jutted out) - Stridor ### Causes - **Pseudo croup:** - Most commonly caused by viral infections, such as the parainfluenza virus, influenza virus, and respiratory syncytial virus (RSV). - **Epiglottitis:** - Most commonly caused by *Haemophilus influenzae* type B bacteria, especially in children who are not vaccinated. - Other causes: - Streptococcus pyogenes - Staphylococcus aureus - Klebsiella pneumoniae - Haemophilus parainfluenza - Streptococcus haemolyticus (A, B, C, and F) - Non-infectious causes include: - Foreign body aspiration - Thermal or chemical injury - Trauma ### Diagnosis - **Pseudo croup:** - Typically diagnosed based on symptoms and physical examination. - Chest x-ray may be ordered to rule out other conditions. - **Epiglottitis:** - Usually diagnosed based on symptoms and physical examination. - **Key findings:** - Epiglottis appears red and swollen ("cherry-red" epiglottis) - Tripod position - Drooling - Stridor - **Investigations:** - Lateral neck x-ray: "thumbprint sign" - Laryngoscopy: rarely performed due to potential for airway obstruction. - Complete blood count (CBC): May show elevated white blood cell count. ### Differential Diagnosis - **Epiglottitis:** - Tracheitis - Retropharyngeal abscess - Foreign body aspiration - Hemangioma of the airway - Peritonsillar abscess - **Pseudo croup:** - Croup - Asthma - Bronchiolitis - Allergic reactions ### Treatment - **Pseudo croup:** - Most cases can be managed at home with supportive care: - Cool mist humidifier - Oral or inhaled corticosteroids - Antibiotics may be prescribed if a bacterial infection is suspected. - Hospitalization may be necessary if breathing difficulties worsen. - **Epiglottitis:** - Requires immediate hospitalization and intensive care. - Treatment includes: - Maintaining a clear airway: Intubation or tracheostomy may be necessary. - Antibiotics: IV antibiotics, such as ceftriaxone or cefotaxime, are given for 7-10 days. - Corticosteroids: Dexamethasone or methylprednisolone are given to reduce inflammation. - Oxygen therapy. ### Prognosis - **Pseudo croup:** - Most children recover fully within a few days. - **Epiglottitis:** - Prompt diagnosis and treatment are essential to prevent potentially life-threatening complications. - With appropriate care, most children recover fully. ### Prevention - **Pseudo croup:** - There is no specific way to prevent pseudo croup. - **Epiglottitis:** - *Haemophilus influenzae* type B vaccination is highly effective in preventing epiglottitis. ### Notes: - The information provided in this document is intended for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.