An infant with fever and stridor

The clinical spectrum of infectious causes of upper airway obstruction has changed dramatically in the last few decades, especially after the introduction of vaccines against diphtheria and Haemophilus influenzae. Nevertheless, infectious causes of upper airway obstruction remain an important source of morbidity and potential mortality in the pediatric age group. Physicians caring for children need to be cognizant of the clinical presentation of this group of disorders because prompt recognition and early appropriate treatment are lifesaving. Epiglottitis, or supraglottitis as some authors prefer, is a potentially life-threatening bacterial infection of the epiglottis and surrounding tissues, including the aryepiglottic folds, the arytenoids, and the supraglottic larynx. Despite the virtual elimination of invasive H. influenzae type B infection, it is important for physicians caring for children to understand the management issues surrounding patients with supraglottitis to avoid disastrous outcomes. As illustrated in the following case, these children may not always present with classic features of supraglottitis.