Epiglottitis

When you mention croup (inflammation of the glottis and subglottis) you always have to exclude epiglottitis and supraglottitis and always keep them in your mind as a possibility of inspiratory stridor in young children.

however-unlike croup- Epiglottitis usually have a rapid, insidous onset with, dramatic development of spiking fever, difficulty of swallowing and rapidly progressive inspiratory stridor manifested by muffling of voice, drooling, and may reach to a complete obstruction of the upper airway, the distressed child may be found in the characteristic sniffing/tripod position, generally the child would appear very sick and toxic, also it's not associated with the characteristic barking cough that features Croup

when you think of the etiology, particularly in a developing country , think of Haemophilus Influenzae type b, and upon medical encounter you may need to ask/check for his vaccination records,
in the U.S. due to routine vaccination , H.Influenzae is no longer regarded as a major cause of Epiglottitis, in fact, S.pyogenes,S.pneumoniae,S.aureus and Mycoplasma are now considered as major causes of Epiglottitis.

                               

                                                                           Sniffing
                                  http://emedicine.medscape.com/article/963773-clinical


when you encounter a case of epiglottitis the first thought should be to secure the airway , never think of X-ray or even providing antibiotics, first think if you need to secure the air way, and you may need an ENT consultation,  you may- upon intubation- visualize the cherry-red inflamed mucosa using the nasopharyngeoscopy, corticosteroids (Inhaled and intravenous) are helpful.

                                                                   Thumb-Print sign
                                    http://www.nejm.org/doi/full/10.1056/NEJMicm1009990


Blood cultures and nasopharyngeal swabs are done to detect infective agent.

X- ray is not needed , though you would see the characteristic thumb-print sign.

the best regimen of antibiotics is to give a combination of ampicillin(anti-staph) or amoxicillin with a third generation cephalosporin (ceftriaxone)

when H-influenzae is diagnosed as the cause , close contacts should receive Rifampin as a prophylaxis .