| Epiglottitis | |
|---|---|
| Other names | Acute supraglottitis |
 | |
| Neck X-ray showing thumbprint sign. | |
| Specialty | Otolaryngology |
| Symptoms | Trouble swallowing, drooling, changes to the voice, fever, increased breathing rate, stridor[1][2] |
| Usual onset | Rapid[1][2] |
| Causes | H. influenzae type b, burns, trauma to the area[1] |
| Diagnostic method | Medical imaging, looking at the epiglottis[3][1] |
| Prevention | Hib vaccine, rifampin[4][5] |
| Treatment | Endotracheal intubation, intravenous antibiotics, corticosteroids[1][2][4] |
| Prognosis | 5% risk of death[3] |
| Frequency | ~2 per 100,000 per year[1][6] |
Epiglottitis is the inflammation of the epiglottis—the flap at the base of the tongue that prevents food entering the trachea (windpipe).[7] Symptoms are usually rapid in onset and include trouble swallowing which can result in drooling, changes to the voice, fever, and an increased breathing rate.[1][2] As the epiglottis is in the upper airway, swelling can interfere with breathing.[7] People may lean forward in an effort to open the airway.[1] As the condition worsens, stridor and bluish skin may occur.[1]
Epiglottitis was historically mostly caused by infection by H. influenzae type b (commonly referred to as "Hib").[1] With vaccination, it is now more often caused by other bacteria, most commonly Streptococcus pneumoniae, Streptococcus pyogenes, or Staphylococcus aureus.[1] Predisposing factors include burns and trauma to the area.[1] The most accurate way to make the diagnosis is to look directly at the epiglottis.[3] X-rays of the neck from the side may show a "thumbprint sign" but the lack of this sign does not mean the condition is absent.[1]
An effective vaccine, the Hib vaccine, has been available since the 1980s.[4] The antibiotic rifampicin may also be used to prevent the disease among those who have been exposed to the disease and are at high risk.[5] The most important part of treatment involves securing the airway, which is often done by endotracheal intubation.[1] Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin is then given.[2][4] Corticosteroids are also typically used.[1] With appropriate treatment, the risk of death among children with the condition is about one percent and among adults is seven percent.[3]
With the use of the Hib vaccine, the number of cases of epiglottitis has decreased by more than 95%.[8] Historically, young children were mostly affected, but it is now more common among older children and adults.[4] In the United States, it affects about 1.3 per 100,000 children a year.[1] In adults, between 1 and 4 per 100,000 are affected a year.[6] It occurs more commonly in the developing world.[9] In children the risk of death is about 6%; however, if they are intubated early, it is less than 1%.[5]
- ^ a b c d e f g h i j k l m n o p Richards AM (February 2016). "Pediatric Respiratory Emergencies". Emergency Medicine Clinics of North America. 34 (1): 77–96. doi:10.1016/j.emc.2015.08.006. PMID 26614243.
- ^ a b c d e Zoorob R, Sidani MA, Fremont RD, Kihlberg C (1 November 2012). "Antibiotic use in acute upper respiratory tract infections". American Family Physician. 86 (9): 817–22. PMID 23113461.
- ^ a b c d Westerhuis B, Bietz MG, Lindemann J (August 2013). "Acute epiglottitis in adults: an under-recognized and life-threatening condition". South Dakota Medicine. 66 (8): 309–11, 313. PMID 24175495.
- ^ a b c d e Schlossberg D (2015). Clinical infectious disease (Second ed.). Cambridge University Press. p. 202. ISBN 9781107038912. Archived from the original on 2016-08-16.
- ^ a b c Blacklow NR (2004). Infectious diseases (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. p. 461. ISBN 9780781733717. Archived from the original on 2016-08-16.
- ^ a b Textbook of Adult Emergency Medicine (4 ed.). Elsevier Health Sciences. 2014. p. 291. ISBN 9780702054389. Archived from the original on 15 August 2016. Retrieved 15 July 2016.
- ^ a b Hamborsky j (2015). "Haemophilus influenzae type b". Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases (13 ed.). Public Health Foundation. p. Chapter 8. ISBN 9780990449119. Archived from the original on 20 July 2016. Retrieved 14 July 2016.
- ^ Des Jardins T (2015). Clinical Manifestations & Assessment of Respiratory Disease (7 ed.). Elsevier Health Sciences. p. 529. ISBN 9780323358972. Archived from the original on 2016-08-15.
- ^ Boons GJ (2009). Carbohydrate-Based Vaccines and Immunotherapies. Hoboken: John Wiley & Sons. p. 1222. ISBN 9780470473276. Archived from the original on 2016-08-15.