Epiglottitis

Epiglottitis: Description:A leaf-shaped plate of elastic cartilage, covered with mucous membrane, at the root of the tongue, which serves as a diverter valve over the superior aperture of the larynx during the act of swallowing; it stands erect when liquids are being swallowed, but is passively bent over the aperture by solid foods being swallowed.Alternative Name: Supraglottitis.Your voice box (larynx) is a framework of cartilage, muscle and mucous membrane that forms the entrance to your windpipe (trachea), the tube that connects your mouth and throat to your lungs. The epiglottis is a flap of tissue that sits at the base of the tongue that keeps food from going into the trachea, or windpipe, during swallowing. When it gets infected and inflamed, it can obstruct, or close off, the windpipe, which may be fatal unless promptly treated.Respiratory infection, environmental exposure, or trauma may result in inflammation and infection of other structures around the throat. This infection and inflammation may spread to involve the epiglottis as well as other upper airway structures. Epiglottitis usually begins as an inflammation and swelling between the base of the tongue and the epiglottis. This may cause the throat structures to push the epiglottis backward. With continued inflammation and swelling of the epiglottis, complete blockage of the airway may occur, leading to suffocation and death. Autopsies of people with epiglottitis have shown distortion of the epiglottis and its associated structures including the formation of abscesses (pockets of infection). For unknown reasons, adults with epiglottic involvement are more likely than children to develop epiglottic abscesses.Children ages 2 to 6 are most susceptible to epiglottitis caused by Hib (Haemophilus influenzae type B vaccine), but since routine childhood Hib Immunizations began in the mid-1980s, the number of children with epiglottitis has dropped dramatically. Today the condition affects about one of every 100,000 adults a year and even fewer children.A conservative estimate of the incidence of epiglottitis is 10-40 cases per million people in the United States. Since 1985, with the widespread vaccination against Haemophilus influenzae type b (or Hib), which was the most common organism related to epiglottitis, the overall incidence of the disease among children has dropped dramatically.Epiglottitis caused by Hib has a unique distribution in that it typically occurs among children aged 2-7 years and has not been reported among Navajo Indians and Alaskan Eskimos.Epiglottitis occurs with different peaks in both children and adults. In children, generally epiglottitis typically peaks in children aged 2-4 years. In adults, it peaks between ages 20-40 years.Epiglottitis in the very young (younger than 1 year) is unusual and occurs in only about 4% of cases.Epiglottitis can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a blood infection (sepsis). Rarely, pulmonary edema, another life-threatening condition, can develop. It occurs when the tiny air sacs in the lungs fill with fluid, preventing them from absorbing oxygen.A person with epiglottitis can recover very well with a good prognosis if the condition is caught early and treated in time. In fact, a good majority of people with epiglottitis do well and recover without problems. But if the person was not brought to the hospital early and was not appropriately diagnosed and treated, the prognosis may range from poor with prolonged physical handicap to death.Symptoms:EpiglottitisThe symptoms of epiglottitis are similar, regardless of the organism causing the inflammation. The following are the most common symptoms of epiglottitis. However, each child may experience symptoms differently. Symptoms may include:
  • Upper respiratory infections (In some children, symptoms of epiglottitis begin with symptoms of an upper respiratory infection.)
As the disease worsens, the following symptoms may appear:
  • Drooling.
  • Unable to talk.
  • The child sits leaning forward.
  • The child keeps his/her mouth open.
Causes and Risk factors:Conditions that cause epiglottitis include infectious, chemical, and traumatic agents. Infectious is the most common. H influenzae type b was once the most common cause prior to vaccination. Currently, other organisms such as bacteria, viruses, and fungi are the causes, especially among adults. Various organisms that can cause epiglottitis include Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus, among others.Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling or eating buffalo fish, which may cause an allergic like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.The most common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn't the germ that causes the flu, but it's responsible for other serious conditions — including respiratory tract infections and meningitis. Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others. Other bacteria and viruses also can cause inflammation of the epiglottis, including:
  • Streptococcus pneumoniae (pneumococcus): Another bacterium that causes meningitis, pneumonia, ear infections and blood infection (sepsis).
  • Streptococcus A, B and C: A group of bacteria that cause diseases ranging from strep throat to blood infections.
  • Candida albicans: The fungus responsible for vaginal yeast infections, diaper rash and oral thrush.
  • Varicella zoster: The virus responsible for chickenpox and shingles.
Injury: Physical injury, such as a direct blow to the throat, can sometime causes epiglottitis.Risk Factors:
  • Sex: Epiglottitis affects more males than females.
  • Crowded conditions: Hib bacteria spread rapidly when people are in close contact, such as in child care centers, and even in households where one person has been infected. If someone in your family has been infected with Hib, all family members need to be evaluated by a physician and receive preventive treatment, if necessary.
  • Weak immune system: If your immune system has been weakened by illness or medication, you're more susceptible to the bacterial infections that may cause epiglottitis.
Diagnosis:Epiglottitis is a medical emergency. Seek immediate medical help. Do not use a tongue depressor (tongue blade) to try to examine the throat at home, as this may make the condition worse.The health care provider will examine the voice box (larynx) using either a small mirror held against the back of the throat or a viewing tube called a laryngoscope. The exam may show a swollen and red epiglottis.Exams and Tests:The doctor may perform x-rays or simply look at the epiglottis and the windpipe by laryngoscopy-a procedure performed in an operating room.
  • The doctor may find that the pharynx is usually inflamed with a beefy cherry red, stiff, and swollen epiglottis.
  • Make no attempt at home to inspect the throat of a person suspected of having epiglottitis.
  • Because manipulation of the epiglottis may result in sudden fatal airway obstruction and because irregular slow heart rates have occurred with attempts at intubation (putting a tube down the throat and placing the person on a machine that helps with breathing), the doctor will use the controlled environment of an operating room to see the throat structures.
Other laboratory tests that doctors use to screen illnesses may include the following:
  • Blood tests to look for infection or inflammation.
  • Arterial blood gas, which measures oxygenation of the blood.
  • Blood cultures, which may grow bacteria and indicate the cause of the epiglottitis.
  • Other immunologic tests looking for antibodies to specific bacteria or viruses.
These laboratory tests may not be useful in diagnosing epiglottitis until the person is stable. Also, the anxiety from having blood drawn or cultures taken from the throat may cause the unstable epiglottis to close off, completely obstructing the airway and creating an emergency with only a few minutes to correct.Other possible diagnoses include infectious causes such as croup, diphtheria, peritonsillar abscess, and infectious mononucleosis.Treatment:Currently, immediate hospitalization is required whenever the diagnosis of epiglottitis is suspected. The person is in danger of sudden and unpredictable closing of the airway. So doctors must establish a secure way for the person to breathe. Antibiotics may be given.
  • Initial treatment of epiglottitis may consist of making the person as comfortable as possible including placing an ill child in a dimly lit room with the parent holding the child, humidified oxygen, and close monitoring. If there are no signs of respiratory distress, IV fluids may be helpful. It is important to prevent anxiety because it may lead to an acute airway obstruction especially in children.
  • People with possible signs of airway obstruction require laryngoscopy in the operating room with proper staff and airway intervention equipment. In very severe cases, the doctor may need to perform a cricothyrotomy (cutting the neck to insert a breathing tube directly into the windpipe).
  • IV antibiotics may effectively control inflammation and get rid of the infection from the body. Antibiotics are usually prescribed to treat the most common types of bacteria. Blood cultures are usually obtained with the premise that any organism found growing in the blood can be attributed as the cause of the epiglottitis. However, in many cases, if not the actual majority, blood cultures fail to yield this information.
  • Corticosteroids and epinephrine have been used in the past. However, there is no good proof that these medications are helpful in cases of epiglottitis.
Continue taking all antibiotics until the full course is completed. Keep all follow-up appointments with your doctor. In the event that a breathing tube had to be placed through the neck, follow-up with the surgeon to have the tube removed and make sure the site is healing well. Most people improve significantly before leaving the hospital, so taking the antibiotics and returning to the hospital if there are any problems are the most important parts of follow-up.Prevention of epiglottitis can be achieved with proper vaccination schedules against H influenza type b (Hib). Therefore it is important that your doctor make the appropriate recommendations for vaccination against Hib for children. Adult vaccination is not routinely recommended, except for people with immune problems such as sickle cell anemia, splenectomy, cancers, or other diseases affecting the immune system.Medicine and medications:Antibiotic therapy is necessary but should be initiated after securing the airway. Prior to culture results, use antibiotics covering the most likely organisms.Medications include:
  • Ceftriaxone (Rocephin).
  • Cefuroxime (Ceftin).
  • Ampicillin (Omnipen, Principen).
  • Chloramphenicol (Chloromycetin).
  • Clindamycin (Cleocin).
  • Ampicillin and sulbactam (Unasyn).
Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care. 

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