Of the 40 children presenting with epiglottitis, eight (20%) presented after the introduction of the Hib conjugate vaccine. [ncbi.nlm.nih.gov]

In earlier studies also dysphagia/odonophagia and fever were the common presenting symptoms [1-3]. In the present study, acute epiglottitis and lingual tonsillitis was also seen in 10 patients. [article.sapub.org]

• Fever

  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]

  Images in Clinical Medicine Casey Grover, M.D. 4 Citing Articles A 58-year-old man presented to the emergency department after having had severe throat pain, hoarseness, and fever for 2 days. [nejm.org]

• Pediatric Disease

  Before the widespread use of its conjugated immunization, Haemophilus influenza type b was the most common cause and it was usually thought of as a pediatric disease process. [pediatriceducation.org]

• Malaise

  Symptoms usually progress slowly and may be associated with chest pain, neck pain, fatigue, malaise, unexplained fever, or weight loss. [ahcmedia.com]

  Symptoms of sore throat from either a viral or bacterial infection can be generalized symptoms that occur throughout the body such as fever, headache, nausea, and malaise. [emedicinehealth.com]

• Stridor

  Factors thought to predict the need of intervention include dyspnea; drooling; stridor and sitting erect, or stridor and drooling; a rapid onset of symptoms; and a history of diabetes mellitus. [prognosisapp.com]

  Administration of adrenaline nebulisers improved the stridor slightly. Blood cultures were taken and intravenous antibiotics and steroids administered. [bmj.com]

  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]

  Stridor, as well as sore throat with a normal-appearing pharynx, are important clues. Examination of the pharynx or larynx in children with epiglottitis and stridor may precipitate complete airway obstruction. [merckmanuals.com]

• Cough

  Case A 2 year old girl presents to the emergency room with fever, cough, runny nose, stridor and difficulty breathing. Temperature is 101, RR 30, there is audible stridor and a barky cough (click on barky cough). [pedclerk.bsd.uchicago.edu]

  This is a 20 month old male who presents to the emergency department with a chief complaint of cough. Two days ago he developed rhinorrhea, fever, a hoarse cry and a progressively worsening, harsh, "barky," cough. [hawaii.edu]

  Finally, a major difference is, in epiglottitis, there's no cough because there are no cough receptors being stimulated. The epiglottis doesn't have any cough receptors. [khanacademy.org]

  Assessment A harsh, barking cough in a febrile, miserable, but otherwise well child suggests Croup. Absent cough with low pitched expiratory stridor (often snoring) and drooling suggests epiglottitis. [rch.org.au]

  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]

• 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]

  Images in Clinical Medicine Casey Grover, M.D. 4 Citing Articles A 58-year-old man presented to the emergency department after having had severe throat pain, hoarseness, and fever for 2 days. [nejm.org]

  Sore throat and hoarseness, frequently with a high fever, develop abruptly in a previously well individual. [medicinenet.com]

• Inspiratory Stridor

  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]

  Symptoms include severe sore throat, dysphagia, high fever, drooling, and inspiratory stridor. Diagnosis requires direct visualization of the supraglottic structures, which is not to be done until full respiratory support is available. [merckmanuals.com]

  Signs and symptoms of epiglottitis include inspiratory stridor, restlessness, cough, dyspnea, fever, and drooling. [smartypance.com]

• Bronchial Breath Sounds

  Lung auscultation may reveal crepitations or bronchial breath sounds if there is associated pneumonia. B. Laboratory Findings. The white blood cell count is elevated with a polymorphonuclear reaction. [internalmedicinejournal.blogspot.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]

  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]

  Diagnosis in adults may be delayed a sore throat and odynophagia are the only complaints and they do not have signs and symptoms of airway obstruction. [waent.org]

• Gagging

  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]

  Indirect laryngoscopy should be done with caution since patient gagging may worsen or participate catastrophic airway obstruction. [waent.org]

Workup Airway management is the most urgent consideration, and patients should first be assessed for level of distress before any other workup. [emedicine.com]

• Subglottic Narrowing

  narrowing and ballooning of hypopharynx no epiglottis thickening inhaled foreign bodies pharyngitis pneumonia peritonsillar abscess retropharyngeal abscess usually clinical following tonsillitis bacterial tracheitis asymmetric subglottic narrowing (intraluminal [radiopaedia.org]

  narrowing (steeple sign) and a normal-sized epiglottis *Also called viral laryngotracheal bronchitis. [merckmanuals.com]

  Chest radiographs may show subglottic narrowing (in 50% of children with croup), but this can also be seen in normal patients. [hawaii.edu]

  Weppner, DO Figure 4: CT Scan of the Neck Revealing Swelling Epiglottis and Aryepiglottic Folds with Significant Subglottic Narrowing From the collection of Justin L. [ahcmedia.com]

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]

The most important part of treatment involves securing the airway, which is often done by endotracheal intubation. Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin is then given. [en.wikipedia.org]

There was no randomized stratification of the patients into different treatment groups being compared. It is possible that different treatment groups might represent different patient populations with different severity of the disease. [anesthesiology.pubs.asahq.org]

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 The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. Most patients can be extubated within several days. [emedicine.com]

In general, the prognosis is good with antimicrobial therapy, close monitoring and selective airway intervention. [ncbi.nlm.nih.gov]

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]

When an etiologic agent is identified, it is usually Hemophilus influenzae. [shmabstracts.com]

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.medscape.com]

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]

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]

[…] also been described in an adult receiving infliximab, prednisone, and azathioprine for Crohn’s disease. 47 Noninfectious causes of epiglottitis should also be considered, including thermal injury, foreign body ingestion, and caustic ingestion. 48-50 Pathophysiology [ahcmedia.com]

Lingual tonsillectomy in these cases may help prevent further recurrent episodes. [ncbi.nlm.nih.gov]

Prevention The Hib vaccine protects most children from epiglottitis. The most common bacteria ( H. influenza type b ) that causes epiglottitis is easily spread. [mountsinai.org]