A 4 years old child presented in emergency with respiratory difficulty and noisy breathing with drooling of saliva. Emergency X-ray showed thumb sign. Diagnosis is:

Ans. b. Epiglottitis (Ref: Ghai 7/e p351; CPDT 18/e p501)A 4 years old child presented in emergency with respiratory difficulty and noisy breathing with drooling of saliva. Emergency X-ray showed thumb sign. Diagnosis is acute epiglottitis.Acute epiglottitisInflammation of epiglottis with inflammatory edema of hypopharynxTrue medical emergencyMC organism responsible for infection: Hemophilus influenza type bClinical Features:Onset is suddenSymptoms: Fever, dysphagia, drooling of saliva, muffled voice, inspiratory retractions, cyanosis and soft stridorPatients often sit in sniffing dog position Imaging:On laryngoscopy: 'Cherry Red' swollen epiglottisX-ray: 'Thumbprint' signTreatment:Immediate endotracheal intubationIV antibiotics for H. influenza Acute epiglottitisAcute laryngotracheobronchitis (Croup)Causative organismHemophilus influenza type bParainfluenza virus type I and IIAge2-7 years3 months to 3 yearsPathologySupraglottic larynxSubglottic areaProdromal symptomsAbsentPresentOnsetSuddenSlowFeverHighLow grade or no feverPatient's lookToxicNon-toxicCoughUsually absentPresent (Barking seal like)StridorPresent and may be markedPresentOdynophagiaPresent, with drooling of secretionsUsually absentRadiologyThumb sign on lateral viewSteeple sign anteroposterior view of neckTreatmentHumidified oxygen, third generation cephalosporin (ceftriaxone) or amoxycillinHumidified O2 tent, steroids