Diagnosis

Epiglottitis

Etiology

Cause [zps]

• Infections in children:

  • Haemophilus influenzae type b (decreased incidence due to the vaccine)

  • Streptococcus pneumoniae

  • Groups A and C β-hemolytic streptococci

  • Staphylococcus aureus

  • Moraxella catarrhalis

  • Haemophilus parainfluenzae

  • Neisseria meningitidis

  • Pseudomonas species

  • Candida albicans, especially in immunocompromised individuals

  • Klebsiella pneumoniae

  • Pasteurella multocida

  • Human immunodeficiency virus

• Infections in adults:

  • H influenzae (25%)

  • H parainfluenza

  • S pneumoniae

  • Group A streptococci

  • Less common bacterial etiologies:

    • Mycobacteria, Bacteroides melaninogenicus, Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, K pneumoniae, N meningitis, and P multocida, Community-acquired methicillin-resistant S aureus

  • Less common viral etiologies:

    • Herpes simplex virus, Epstein-Barr virus

  • In immunocompromised patients: Candida and Aspergillus

• Noninfectious etiology:

  • Traumatic (thermal injuries with throat burns, dishwasher detergent ingestion)

  • Angioneurotic edema

  • Acute leukemia

  • Hemophagocytic lymphohistiocytosis

  • Smoking crack cocaine or marijuana

Pathophysiology

1. Inflammatory edema --> Epiglottic swelling

2. Airway obstruction:

   • Distal mucus plugging

   • Aspiration of oropharyngeal secretions

   • Respiratory arrest

3. Bacterial penetration of the mucosal barrier --> bacteremia --> infections in the meninges, skin, lungs, ears, and other areas

Risk factors [zps]

• Unimmunized (not vaccinated)

• Immunocompromised patients

• Age around 45 years

• BMI > 25 kg/m2

• Diabetes mellitus

• Man-to-woman ratio: 3:1

• Epiglottic cyst

• Pneumonia

• Sjögren syndrome

Complications [zps]

• Cervical adenitis

• Cellulitis

• Empyema

• Epiglottic abscess

• Meningitis

• Pneumonia

• Pulmonary edema

• Pneumothorax

• Hypoxemia

• Sepsis

• Septic arthritis

• Septic shock

• Vocal cord granuloma

• Ludwig angina-type submental infection

• Respiratory arrest

• Cardiac arrest

• Death

Epidemiology

Incidence per 100.000 [rwr][dk1][pw5][8km]

Approach

• Soft tissue radiographs

• Laryngoscopy

Treatment

1. Maintenance of an airway: [pw5]

   • Mild case: close observation in an intensive care unit

   • Serious case: elective intubation, emergent tracheostomy

2. Antibiotics:

   • H. influenzae

   • Beta hemolytic streptococci

3. Corticosteroids to reduce edema

Differential diagnoses

Acute laryngitis, Allergy, Anaphylaxis, Angioedema, Croup, Diphtheria, Foreign body, Inhalation injury, Laryngomalacia, Laryngospasm, Ludwigs angina, Mononucleosis, Peritonsillar abscess, Pertussis, Retropharyngeal abscess, Sepsis, Wegener's granulomatosis