Antibiotics will cure infection that endangers a child's airway


November 26, 1991|By Dr. Modena Wilson and Dr. Alain Joffe

Q: A distant relative's child just had something called "epiglottitis." My mother said the doctor had to put a hole in his neck. Is this a strange new disease? I'm worried my son might get it.

A: Epiglottitis is not new, but fortunately it is relatively rare. The epiglottis is a thin flap of tissue beyond the back of the tongue that flops down to cover the opening into the trachea (the major airway that acts like a valve to guide food and drink into the stomach and to keep it out of the lungs. As soon as a swallow is over, the epiglottis moves off the airway so breathing can resume.

A particular type of bacteria, called Haemophilus influenzae, seems to infect the epiglottis of young children. A child with this infection, epiglottitis, usually gets very sick suddenly, has a high fever and a very sore throat, and has trouble swallowing, talking and breathing. Epiglottitis it a true emergency, because there is very little space for the child to breathe around the swollen epiglottis. If left untreated, the epiglottis may block the airway entirely, and the child will suffocate.

Treatment for epiglottitis includes giving antibiotics to kill the bacteria. But getting rid of the infection takes time, and that is where the hole in the neck comes in. Doctors must make sure a child with epiglottitis can breathe until the antibiotics to work. To assure breathing, a plastic tube is placed to carry air to the lungs either through the mouth or nose, past the swollen epiglottis, into the trachea, or through a hole in the neck into the trachea below the epiglottis. it sounds as though your relative's son had the latter, which is often called a tracheostomy.

The good news is that epiglottitis can be cured quickly and without long-lasting problems.

The bacteria that cause epiglottitis can spread to other people. To prevent this, doctors seek out and treat people who spent enough time with a patient to become infected. Fortunately, vaccines to immunize young children against the bacteria that cause most cases of epiglottitis are now available.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

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