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https://upload.medbullets.com/topic/104048/images/epiglottitis_endoscopy.jpg
Snapshot
  • A 6-year-old boy is brought to the pediatric emergency department after developing difficulty with breathing. Per his mother, his symptoms began approximately 3 hours ago and have progressively worsened. She endorses that he had an upper respiratory infection 1 week prior. His temperature is 102°F (38.9°C), blood pressure is 100/65 mmHg, pulse is 105/min, and respirations are 28/min. Physical examination is notable for him appearing distressed with inspiration and leaning forward with his neck hyperextended and chin thrust forward. Laryngoscopy demonstrated an erythematous and edematous epiglottis. (Epiglottitis)
Introduction
  • Classification
    • gram-negative rod
  • Epidemiology
    • incidence
      • nontypeable bacteria most commonly cause otitis media
  • Transmission
    • respiratory
  • Microbiology
    • oxidase positive
    • facultatively anaerobic
    • nonmotile
    • polysaccharide capsule
      • there are 6 types of capsules; however, type b is commonly associated with invasive disease
      • organisms without a capsule are said to be nontypeable
    • IgA protease
  • Associated conditions
    • encapsulated (type b) strains
      • meningitis
      • epiglottitis
      • septic arthritis
    • nonencapsulated strains
      • otitis media
      • pulmonary disease in patients with preexisting lung disease (e.g., chronic bronchitis and viral influenza infection)
  • Prognosis
    • haemophilus influenzae type b conjugate vaccine
      • provides active immunization, which is important in preventing Hib infection
Studies
  • Chocolate agar 
    • requires factors V (NAD+) and X (hematin) for growth 
  • Grows near S. aureus on blood agar
    • S. aureus supplies factor V
Presentation
H. influenzae Clinical Presentation
Disease
Presentation
Diagnostic Studies Treatment
Meningitis
  • Symptoms
    • headache
    • nausea
    • vomiting
  • Physical exam
    • nuchal rigidity
    • Brudzinki sign
      • spontaneous flexion of the hips during passive neck flexion
    • Kernig sign
      • inability to extend the knees while the hips are flexed at 90°
  • Lumbar puncture
  • Ceftriaxone or cefotaxime
Epiglottitis
  • Symptoms
    • dysphagia
  • Physical exam
    • drooling
    • fever
    • muffled voice
    • stridor
    • trunk leaning forward, neck hyperextended, and chin thrust forward 
  • Laryngoscopy 
  • Blood and epiglottic cultures
  • Airway protection
  • Ceftriaxone or cefotaxime
Septic arthritis
  • Symptoms
    • swollen and painful joint
  • Physical exam
    • joint tenderness
  • Synovial fluid analysis and culture
  • Cephalosporin
Otitis media
  • Symptoms
    • irritability
    • headache
    • ear pain
  • Physical exam
    • ear tugging/tugging
  • Clinical diagnosis
  • Tympanocentesis can be considered when an etiologic diagnosis is needed
  • Amoxicillin or amoxicillin-clavulanate
 

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