A 3-year-old child presents with sudden onset inspiratory stridor, fever 39°C, drooling, and sitting in tripod position. X-ray lateral neck shows widening of the epiglottis ('thumb sign'). The most common causative organism is:

• A Streptococcus pyogenes
• B Staphylococcus aureus (methicillin-sensitive)
• C Haemophilus influenzae type b (Hib) ✓
• D Streptococcus pneumoniae

Explanation

Acute epiglottitis (supraglottitis) in children was classically caused by Haemophilus influenzae type b (Hib), which caused the 'cherry red epiglottis' seen on laryngoscopy and the 'thumb sign' on lateral neck X-ray. Since universal Hib vaccination (started in India as part of pentavalent vaccine), the incidence has dramatically decreased and adults now present more commonly with mixed bacterial causes. Management requires immediate airway securing (intubation or tracheostomy) and intravenous cefotaxime/ceftriaxone. Croup (laryngotracheobronchitis) is caused by parainfluenza virus and shows the 'steeple sign,' not the thumb sign.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.