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Acute Epiglottitis


Presentation

  • Of the 40 children presenting with epiglottitis, eight (20%) presented after the introduction of the Hib conjugate vaccine.[ncbi.nlm.nih.gov]
  • A discussion of airway management in adult epiglottitis is presented.[ncbi.nlm.nih.gov]
  • The authors present two cases of acute epiglottitis with upper airway obstruction that urgently needed artificial airways. In case 1, a 55-year-old woman with DM presented with severe upper airway obstruction and sepsis.[ncbi.nlm.nih.gov]
  • The present report describes a rare case of Hib-induced acute epiglottitis and presents the key findings of forensic investigations in this type of disease.[ncbi.nlm.nih.gov]
  • BACKGROUND: To examine the common presentations and management of acute epiglottitis in adults.[ncbi.nlm.nih.gov]
Fever
  • We describe a 48-year-old woman with epiglottitis and associated typical rapid onset of sore throat, fever, respiratory distress, and swollen, red supraglottic structures.[ncbi.nlm.nih.gov]
  • She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia.[ncbi.nlm.nih.gov]
  • Abstract In order to determine the aetiology of acute epiglottitis in adults, blood cultures, paired sera and a urine sample were obtained from 54 patients with fever and epiglottitis visualized by indirect laryngoscopy or by direct fibreoptic nasolaryngoscopy[ncbi.nlm.nih.gov]
  • Common presenting symptoms included sore throat, dysphagia, and low-grade fever. The predominant postmortem findings included hyperemia and edema of the epiglottis and aryepiglottic folds.[ncbi.nlm.nih.gov]
  • He had developed acute-onset throat and abdominal pain and a high fever. Despite an emergency cricothyrotomy due to a complicated intubation because of a massively swollen epiglottis, the efforts to resuscitate the child were unsuccessful.[ncbi.nlm.nih.gov]
Stridor
  • The incidences of drooling, stridor/dyspnea, and muffled voice were significantly higher in the airway-supported group ( P 0.05). Stridor/dyspnea is a reliable clinical predictor of airway compromise (odds ratio 2.94; P 0.0277).[ncbi.nlm.nih.gov]
  • We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention.[ncbi.nlm.nih.gov]
  • Significant predictors for airway intervention included the sex of the patient, stridor, presence of airway compromise on examination and a "thumb sign" on the lateral neck radiograph.[ncbi.nlm.nih.gov]
  • Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.[ncbi.nlm.nih.gov]
  • In multivariate analysis, factors associated with airway intervention were stridor (relative risk [RR], 6.2; 95% confidence interval [CI], 1.7 to 22.9) and sitting erect (RR, 4.8; 95% CI, 1.3 to 16.1).[ncbi.nlm.nih.gov]
Hoarseness
  • Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count.[ncbi.nlm.nih.gov]
  • A 78-year-old female patient presented to our emergency department with a 5-day history of throat pain, hoarseness and a progressive and dolorous submandibular swelling.[ncbi.nlm.nih.gov]
  • The clinical manifestations were sore throat (100%), fever (88%), dyspnea (78%), dysphagia (76%), anterior neck cellulitis or tenderness (27%), hoarseness (21%), pharyngitis (20%) and anterior cervical lymphadenopathy (9%).[ncbi.nlm.nih.gov]
  • Sore throat and hoarseness , frequently with a high fever , develop abruptly in a previously well individual.[medicinenet.com]
  • Sore throat and hoarseness, frequently with a high fever, develop abruptly in a previously well individual.[medicinenet.com]
Cough
  • Cover your mouth when you sneeze or cough. Wash your hands after you cough, sneeze, or use the bathroom. Ask your healthcare provider if other family or household members need antibiotic medicine to prevent infection.[drugs.com]
  • Have your child cover his mouth when he sneezes or coughs. Have him wash his hands after he coughs, sneezes, or uses the bathroom. Ask your child's healthcare provider if he needs to stay away from other children.[drugs.com]
  • Other problems that affect the throat include Tonsillitis - inflammation of the tonsils Cancer Croup - inflammation, usually in small children, which causes a barking cough Laryngitis - swelling of the voice box, which can cause a hoarse voice or loss[icdlist.com]
  • Signs and symptoms of epiglottitis include inspiratory stridor, restlessness, cough, dyspnea, fever, and drooling.[smartypance.com]
  • . - Other signs and symptoms include the following: - Dyspnoea; - Stridor; - Dysphonia; - Drooling; - Tachycardia; - Tachypnoea; - Hypoxia; - Cough. - If the airways become totally blocked and emergency treatment is not provided, acute epiglottitis can[nursingtimes.net]
Inspiratory Stridor
  • Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.[ncbi.nlm.nih.gov]
  • On admission the patient was ill and severely distressed, sitting in the upright position, drooling saliva, showing severe inspiratory stridor, hyperventilation, but no trismus.[ncbi.nlm.nih.gov]
  • Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature or 38 degrees[ncbi.nlm.nih.gov]
  • Signs and symptoms of epiglottitis include inspiratory stridor, restlessness, cough, dyspnea, fever, and drooling.[smartypance.com]
  • The first signs-sore throat, hoarseness, fever, and dysphagia-may be followed by an inability to swallow, drooling, varying degrees of dyspnea, inspiratory stridor, marked irritability and apprehension, and a tendency to sit upright and hyperextend the[medical-dictionary.thefreedictionary.com]
Odynophagia
  • Other important clinical factors to consider are odynophagia, drooling, hoarseness, muffled voice, dyspnoea, swelling of the posterior side of the epiglottis and a high WBC count.[ncbi.nlm.nih.gov]
  • The most common symptoms were sore throat (95%) and odynophagia (94%); the most common signs were muffled voice and evidence of pharyngitis.[ncbi.nlm.nih.gov]
  • Acute epiglottitis should be suspected in all patients with a history of sore throat and odynophagia, especially if symptoms are out of proportion to pharyngel findings.[arquivosdeorl.org.br]
  • Pain while swallowing (Odynophagia) - 4 days 3. Drooling of saliva - 4 days 4. Change in voice - 4 days On examination: Drooling of saliva Hot potato voice Indirect laryngoscopy: Showed swelling of epiglottis, aryepiglottic folds.[drtbalu.wikidot.com]
Gagging
  • Indirect laryngoscopy should be done with caution since patient gagging may worsen or participate catastrophic airway obstruction.[waent.org]
  • In our case, oral local anesthetic spray did not completely abolish gag reflexes and pain. Gag reflex, due to moderate discomfort during fiberoptic intubation, traumatized the pharynx but fortunately left the abscess intact [Figure 3].[joacp.org]
Abdominal Pain
  • He had developed acute-onset throat and abdominal pain and a high fever. Despite an emergency cricothyrotomy due to a complicated intubation because of a massively swollen epiglottis, the efforts to resuscitate the child were unsuccessful.[ncbi.nlm.nih.gov]
Arthralgia
  • She presented with high fever, arthralgia, general fatigue and strong throat pain. Laryngeal fiberscopy showed a markedly swollen epiglottis suggestive of acute epiglottitis, though she had no signs of asphyxia.[ncbi.nlm.nih.gov]
Encephalopathy
  • A diagnosis of probable posterior reversible encephalopathy syndrome (PRES) was made. Figure 2 CT brain reveals multiple areas of abnormal hypodensity in the subcortical white matter of both hemispheres .[ped-rheum.biomedcentral.com]
  • A diagnosis of probable posterior reversible encephalopathy syndrome (PRES) was made. Figure 2 CT brain reveals multiple areas of abnormal hypodensity in the subcortical white matter of both hemispheres.[ped-rheum.biomedcentral.com]

Workup

  • Workup Airway management is the most urgent consideration, and patients should first be assessed for level of distress before any other workup.[emedicine.com]
  • A week later, her autoimmune and serologic workup came back positive for anti-nuclear antibody (ANA) at a titer of 1: 1280, positive anti-double stranded DNA, lupus anticoagulant, anticardiolipin antibody (ACA IgG was elevated at 6.1 MoM) and low complements[ped-rheum.biomedcentral.com]
Subglottic Narrowing
  • narrowing (steeple sign) and a normal-sized epiglottis *Also called viral laryngotracheal bronchitis.[merckmanuals.com]
Blood Culture Positive
  • Study by Wong et alalso revealed three blood cultures positive ( Haemophilus influenza in two cases and streptococcus mitis in one case) out of 14 cases (11). However Hugosson et al (9) study quoted 68% as a negative blood cultures.[arquivosdeorl.org.br]
  • It is noteworthy that two of the electively intubated patients had blood cultures positive for H. influenzae, whereas none of the conservatively treated patients did. Limitations of Our Study First, our study is a retrospective review.[anesthesiology.pubs.asahq.org]

Treatment

  • The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy.[ncbi.nlm.nih.gov]
  • The purpose of this study was to retrospectively analyze diagnostic and treatment methods in adults with epiglottitis seen over a 10-year period at the Winnipeg Health Sciences Centre.[ncbi.nlm.nih.gov]
  • We aimed to evaluate the effectiveness of empiric intravenous ampicillin in the treatment of patients with AE.[ncbi.nlm.nih.gov]
  • The mainstays of treatment are airway maintenance, antibiotics, steroids, hydration, cool mist, oxygen and supportive care.[ncbi.nlm.nih.gov]
  • Subsequent progress was satisfactory following endotracheal intubation and treatment with ampicillin and hydrocortisone. Blood cultures grew Haemophilus influenzae.[ncbi.nlm.nih.gov]

Prognosis

  • In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention.[ncbi.nlm.nih.gov]
  • Prognosis: • The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. • Most patients can be extubated within several days. • However, unrecognized epiglottitis may rapidly lead to airway compromise and resultant[slideshare.net]
  • Prognosis Expeditious diagnosis, immediate management of upper-airway obstruction, and institution of antibiotics decreases morbidity and mortality related to acute epiglottitis. Full recovery without sequelae is expected in such patients.[internalmedicinejournal.blogspot.com]
  • Epiglottitis in the United States: national trends, variances, prognosis, and management. Laryngoscope. 2010 Jun;120(6):1256-62. Guardiani E, Bliss M, Harley E.[pediatriceducation.org]

Etiology

  • Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, Streptococcus pneumoniae six, H. parainfluenzae two, Streptococcus pyogenes one). In the remaining cases, the etiology was uncertain.[ncbi.nlm.nih.gov]
  • Streptococcus spp. infection represented the main etiology. Outcome was favorable if early respiratory tract protection could be performed in good conditions. Morbidity and sequelae were greater in patients requiring airway intervention.[ncbi.nlm.nih.gov]
  • When an etiologic agent is identified, it is usually Hemophilus influenzae.[shmabstracts.com]
  • In fact, this organism is the most common etiologic agent associated with epiglottitis, which has a thumbprint sign seen on X-ray. Ceftriaxone antibiotic is commonly used for treatment in severe cases.[smartypance.com]

Epidemiology

  • Abstract Over a period of 18 years 219 consecutive cases of acute epiglottitis were diagnosed and subsequently investigated in order to elucidate the aetiology, epidemiology and outcome of this disease in a well-defined population in Sweden before general[ncbi.nlm.nih.gov]
  • OBJECTIVES: We studied the incidence and bacterial epidemiology of acute epiglottitis presenting in the first 16 years following the introduction of general childhood vaccination against Haemophilus influenzae type b.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: There have been significant changes in the clinical epidemiology of epiglottitis, which now occurs almost exclusively in adults, often with less severe symptoms and a lower incidence of H influenzae infection.[ncbi.nlm.nih.gov]
  • The dramatic change in the epidemiology of pediatric epiglottitis . Pediatr Emerg Care 2006 ; 22 : 443 –4 6 Torkkeli , T , Ruoppi , P , Nuutinen , J , Kari , A .[cambridge.org]
  • There also appears to be a 60% male predominance, which has remained true even with the changing epidemiology of epiglottitis. Epiglottitis was once believed to occur exclusively in children.[emedicine.com]
Sex distribution
Age distribution

Pathophysiology

  • After the third recurrence, careful consideration was given to possible pathophysiologic mechanisms and potential therapeutic options. Further recurrence was prevented effectively by performing a lingual tonsillectomy.[ncbi.nlm.nih.gov]
  • Risk factors in adults include hypertension, diabetes mellitus, substance abuse, immune deficiency, and airway trauma. return to top Pathophysiology Infectious epiglottitis results from bacteremia or from direct spread to the epithelial layer of the epiglottis[sharinginhealth.ca]
  • It is important for anaesthetists and intensive care specialists to be able to manage upper airway obstruction resulting from acute epiglottitis and have a clear understanding of the aetiology and the pathophysiology of this condition.[ispub.com]
  • Pathophysiology, evaluation and treatment of the difficult airway. Anesth Clin North Am 1998;16:29-75. 6. Muller BJ, Fliegel JE. Acute epiglottitis in a 79-year-old man. Can Anaesth Soc J 1985;32:415-7. [ PUBMED ] [Figure 1], [Figure 2], [Figure 3][joacp.org]

Prevention

  • Lingual tonsillectomy in these cases may help prevent further recurrent episodes.[ncbi.nlm.nih.gov]
  • The overall efficacy of the immunization program in preventing acute epiglottitis, therefore, is estimated to be 84.6%.[ncbi.nlm.nih.gov]
  • The importance of being aware of this diagnosis is to prevent an acute upper airway obstruction that can be potentially fatal.[ncbi.nlm.nih.gov]
  • How can I prevent epiglottitis from happening again? Ask your healthcare provider if you need the Hib vaccine. This vaccine helps prevent Hib infection and problems such as epiglottitis.[drugs.com]

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