Bacterial epiglottitis

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Bacterial epiglottitis

Respiratory system


Bacterial epiglottitis


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Bacterial epiglottitis

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USMLE® Step 1 style questions USMLE

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A 28-year-old man with polysubstance use disorder presents to the emergency department with fever, dyspnea, and stridor. The patient is diagnosed with epiglottitis. He is started on intravenous antibiotics and later undergoes endotracheal intubation for airway protection. He did not receive most of the childhood immunizations. Blood and sputum cultures are collected. Which of the following agars is most likely to grow the organism responsible for this patient’s infection?  

External References

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Haemophilus influenzae p. , 140

labs/findings p. 720

unvaccinated children p. 183


epiglottitis p. 183


With Epiglottitis, “itis” means inflammation and epiglottis is a flap of elastic cartilage that sits at the top of the larynx or voice box. The epiglottis keeps food and liquid going down the esophagus and prevents it from going down the trachea by accident. So bacterial epiglottitis is when bacteria infect this flap of tissue and cause it to get swollen. This can be life threatening because it can flop down and block the trachea, making it impossible to breathe. This infection is actually thought to have been the cause of death for George Washington, America’s first president.

Now, the larynx is located in the bottom portion of the neck, just below where the pharynx splits into the trachea and the esophagus. The larynx is also called the voice box because it contains the vocal cords, which are two folds of mucous membrane that can open and close like curtains. Just like the rest of the respiratory tract, the walls of the larynx are made up of mucosal epithelium.

The epiglottis extends from the base of the tongue and anchors to the anterior rim of the thyroid cartilage, which is just in front of the larynx. The lateral borders of the epiglottis connect to the aryepiglottic folds, which have ligamentous and muscular fibers. This allows the epiglottis to act like a lid on a box and serve as the guardian of the airways. During swallowing, the epiglottis covers the larynx, preventing food and liquids from entering the airway; and during breathing, the epiglottis opens the larynx, allowing air to flow in and out.


Bacterial epiglottitis is a rare, vaccine-preventable, life-threatening form of epiglottitis caused by bacteria, usually, Haemophilus influenzae type B. Symptoms typically include fever, sore throat, difficulty swallowing, and difficulty in breathing in case the airway becomes obstructed by the inflamed epiglottis. The epiglottis is a flap of cartilage at the back of the throat that helps to keep food from entering the airways. In bacterial epiglottitis, the epiglottis becomes infected and swells, blocking the airway.


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  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Anatomy and Physiology of Feeding and Swallowing: Normal and Abnormal" Physical Medicine and Rehabilitation Clinics of North America (2008)
  6. "Acute epiglottitis in the era of post-Haemophilus influenzae type B (HIB) vaccine" Journal of Anesthesia (2012)

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