WALTER E. BERMAN, M.D., and
ALAN E. HOLTZMAN, M.D., Beverly Hills
MANY PHYSICIANS are but little aware of acute epi-
glottitis as a potentially serious and sometimes fatal
disease of infants and children. Although the con-
dition was recognized at the turn of the century,
only in the last five years has it been included as a
distinct entity in pediatric textbooks."2
Acute epiglottitis is not a rare disease. Miller7
said that at one hospital about one case a month is
observed. Berenberg and Kevy2 reported on 42 pa-
tients with the disease observed in an eight-year
period, only one of whom was referred to the hos-
pital with the correct diagnosis. In light of these
facts, it behooves physicians who may be called
upon to attend children to become better acquainted
with this disease and to be prepared to treat it as
REPORT OF A CASE
A six-year-old boy was admitted to the U.C.L.A.
Medical Center with acute upper respiratory tract
obstruction. He had been well until the morning
before admission, when he complained of sore
throat and anorexia. The body temperature gradu-
ally rose. At 2 o'clock in the afternoon the patient
was examined by a physician who noted mild phar-
yngitis and fever and prescribed a tetracycline
That evening at 8 o'clock difficulty in breathing
became apparent and when the physician observed
him the patient was sitting up in bed, drooling and
having moderate inspiratory stridor. The alae nasae
flared, and suprasternal, intercostal and lower sternal
retractions were prominent. The epiglottis, easily
visualized by depressing the tongue with a tongue
blade, was decidedly inflamed and edematous.
Upon arrival at the hospital, the patient was given
chloramphenicol intramuscularly and cold steam
inhalations were started. When his condition did
not improve in two hours, tracheotomy was done.
Breathing immediately became easier and by the
following morning the patient was afebrile and had
no respiratory distress. Chloramphenicol was con-
tinued by mouth and the tracheotomy tube was re-
moved after four days. He was discharged on the
fifth day. The leukocyte content of the blood at the
time of admittance to hospital was 26,900 per cu.
Submitted June 29, 1959.
* Although acute epiglottitis is not a rare disease
and may be very severe or fatal, it is one not fa-
miliar, as it should be, to all physicians dealing
Diagnosis may be confirmed clinically by di-
rect or indirect examination of the epiglottis.
Vaporized cool water is preferable to steam for
reducing the swelling of mucosal tissues that im-
Chloramphenicol is the drug of choice, as the
majority of cases of acute epiglottitis are due to
Tracheotomy must be carried out if necessary
to maintain an airway.
mm.-69 per cent neutrophils, 13 per cent banded
forms and 15 per cent lymphocytes. No significant
organisms grew on cultures of the blood and ma-
terial from the throat, trachea and epiglottis.
Hemophilus influenza, type B, has been generally
considered to be the causative agent in acute epi-
glottitis. This organism has been the most common
one recovered from the throat and from the blood
of patients with this disease, although other bacteria
have grown on cultures in some instances.
believe that this disease,
along with most infections of the respiratory tract,
is brought about by some precursor disease, most
commonly a viral infection, with secondary com-
plications caused by organisms which may be pres-
ent in the respiratory tract at the time.
This condition usually affects children between
two and six years of age and commonly occurs in
the late fall, winter and early spring. Camps5 re-
ported four cases in infants under one year of age.
A very interesting case in a 12-year-old, considered
to have bulbar poliomyelitis, was reported by Gun-
dell.6 Brewer and Rambo3 have reported cases in
The onset of the disease is abrupt, fever and sore
throat being the prominent findings. A younger
child may merely gag when drinking. Early in the
course of the condition the pharynx is mildly hy-
peremic and some of the anterior cervical lymph
nodes slightly tender. Dyspnea may or may not be
VOL. 92. NO. 5* MAY 1960