A 5-year-old unimmunized child develops high fever, drooling, a 'hot potato' voice, and severe odynophagia. The child insists on sitting in a tripod position. Direct laryngoscopy is avoided. What is the MOST likely causal organism and the BEST initial management step?
- A Group A Streptococcus; immediate throat swab for culture and IV amoxicillin
- B Parainfluenza virus; cool mist humidification and oral dexamethasone
- C Haemophilus influenzae type b; secure airway in controlled setting and start IV ceftriaxone ✓
- D Staphylococcus aureus; incision and drainage of retropharyngeal abscess
Explanation
Acute epiglottitis presents with rapid onset, high fever, drooling, muffled 'hot potato' voice, severe odynophagia, and the tripod/sniffing position. In unimmunized children, Haemophilus influenzae type b (Hib) remains the primary cause. This is an airway emergency—the priority is airway security (intubation in the operating room by experienced personnel) before any throat examination, which could precipitate complete airway obstruction. IV ceftriaxone (covering Hib) is the antibiotic of choice. Parainfluenza causes croup (barking cough, stridor) not epiglottitis. Retropharyngeal abscess has a different presentation.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.