The incidence of epiglotitis has been reduced dramatically with the widespread use of Hib vaccine. Epiglotitis is usually seen in children between 2-7 years old, with a peak incidence at about 3.5 years. Respiratory distress is frequently the first manifestation of the infection. Generally the child is well until several hours prior to the appearance of symptoms. A child with epiglotitis usually looks toxic, anxious, and remarkably still, sitting bolt upright with neck extended and the head hold forward with drooling, stridor, and muffled voice.
Some children present with a similar history, but milder symptoms and signs.
In these cases presentation is either early, or the child is older than average. During the course of epiglotitis, pneumonia, cervical lymphadenitis, otitis, or rarely, meningitis or septic arthritis may occur. Epiglotitis is a medical emergency. The patient with epiglotitis needs hospitalization, use of artificial airway until respiratory condition is stable, and intravenous antibiotic therapy. The most common sites of involvement are the head and neck, particularly the cheek and preseptal region.