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A fatal sore throat - Brief Article

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"It was the bane of my existence during my early years in practice," states Dr. Glenn Isaacson, now Professor and Chairman of Otolaryngology at Temple University School of Medicine. "Lots of driving through red lights to get to the hospital."

The disease he refers to is epiglottitis, or, to use its more precise name, supraglottitis. This bacterial infection of the tissues directly above the vocal cords. Epiglottitis causes rapid swelling of these tissues which fall back over the airway and block it, causing death by asphyxiation.

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The usual cause is a bacterium called Haemophilus influenzae type B. Because of wide spread vaccination against it, this bacterium is not commonly found in children today. This has caused the incidence of epiglottitis in children to drop from around 12 cases to one for every 100,000 children.

On its face, the dramatic fall in numbers is a triumph for modern medicine. However, the reduced incidence does have its downside. H. flu type B is by far the most common, but not the only bacterium capable of causing this condition. Certain streptococcal and staphylococcal infections, viruses, and fungi have also been known to trigger the disease.

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A Fatal Sore Throat - Brief Article
"It was the bane of my existence during my early years in practice," states Dr. Glenn Isaacson, now Professor and Chairman of .....
Unfortunately, the lack of cases has led to an inevitable lack of first hand observation for many medical professionals. Because the disease is much less common, it is feared that many primary care physicians and emergency room personnel are less likely to consider the diagnosis. "This is a big problem," says Dr. Isaacson. "Many younger practitioners, (aged 40 and younger) have never seen a case."

His point is well made. Epiglottitis is a relatively easy disease to treat, but it requires immediate attention. Dr. Isaacson goes on to state: "Epiglottitis can cause death within hours and so is one of the true medical emergencies in young children. There is nothing useful to do at home. The child should be brought to the emergency room. There, a plastic tube is placed in the airway to prevent asphyxiation. Antibiotics are given by vein ... Delayed or improper management might result in death."

Not An Ordinary Sore Throat
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So how does a parent know whether their child has this potentially fatal illness or merely a bad cold? Dr. Isaacson tells us what to look out for: "There is a very rapid onset of severe illness, high fever, hoarse voice, and drooling. Children make a coarse inspiratory noise called stridor. They tend to sit upright and lean forward as they gasp for breath. They don't cough and are afraid to move or lie down."

Any child suspected of having epiglottitis should never have their throat examined with a tongue depressor (throat stick). Doing so can worsen the swelling, and in some cases cause the complete obstruction of the airway. The throat should be examined by a physician who has the skills and equipment to treat any sudden blockage of the child's airway.

A parent is their child's best advocate. If your gut feeling tells you that there is something seriously wrong with your child, you should not rely on the first impression of a physician, who does not know your child the way you do. Most physicians will tell you they prefer a proactive parent, even if it means a challenge to their diagnosis.
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Sue Shackles is a freelance writer based in Washington State. Her parenting, health and humor articles have appeared in many publications.

COPYRIGHT 2001 Pediatrics for Parents, Inc.
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COPYRIGHT 2002 Gale Group

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