INTRODUCTION – AGENTS
Respiratory failure is the most common cause of cardiopulmonary arrest in infants and children. Because morbidity may be time-dependent and appropriate treatment may vary significantly depending on etiology, prompt assessment and management of pediatric respiratory disease is essential. This chapter will discuss the most common respiratory diseases in children focusing on epiglottitis, bacterial tracheitis, croup, retropharyngeal abscess, pertussis, bronchiolitis, and pneumonia.
Epiglottitis or supraglottitis is a serious, life-threatening infection of the epiglottis and constitutes an airway emergency (see Chapter 8 for a discussion of supraglottitis). It is more common in the winter but can occur throughout the year. Peak incidence is in children between 2 and 8 years of age, but epiglottitis also occurs in infants and adults. Since widespread vaccination against Haemophilus influenzae type B, previously the most common cause, the incidence has decreased from 41 to 4.1 cases per 100,000, and the typical age of presentation is increasing. The most common identified organisms causing epiglottitis are now group A beta-hemolytic Streptococcus, Streptococcus pneumoniae, Klebsiella, Pseudomonas, and Candida.
Epiglottitis usually presents abruptly within 6–24 hours of a prodromal viral illness. Patients with epiglottitis classically have high fever, irritability, and throat pain that may manifest as unwillingness to eat or drink (Table 49.1).