Epiglottitis Causes and Treatment

What Is Epiglottitis?

Epiglottitis is a life-threatening bacterial infection that occurs in the epiglottis, a small portion of cartilage that covers the windpipe, swelling and obstruction of the airflow into the airways.

Epiglottitis Signs And Symptoms

Epiglottitis is characterized by

Fever

Hoarseness Of Voice

Throat Discomfort

Stridor

difficulty swallowing

Typically, the onset occurs after one day. The pharynx may appear to be unremarkable.


Adults typically exhibit less severe respiratory symptoms than children due to their wider airways. Consequently, their primary symptoms are typically a severe hoarse larynx and difficulty swallowing.Epiglottitis should be considered when there is pain that is out of proportion to the exam or when the pain is induced by pressure on the external windpipe, especially since the back of the esophagus appears normal in 90% of adult patients. Supraglottitis is a term frequently used to describe adult epiglottitis. In contrast to infants, the symptoms are non-specific, subacute, and may be unpredictable.

Causes Of Epiglottitis

Epiglottitis is predominantly caused by an acquired bacterial infection of the epiglottis. Haemophilus influenzae type B was the culprit most frequently in the past; however, this is no longer the case due to the availability of vaccination.H. influenzae type B is equipped with a capsule that prevents it from being eliminated by macrophages. Additionally, it contains surface proteins that enable it to adhere to the upper respiratory tract epithelium.

At present, Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus are the bacteria that cause infection most frequently.

Diagnosis Of Epiglottitis

Diagnosis Direct inspection with a laryngoscope may confirm the diagnosis, but this may induce airway spasm. In the event that epiglottitis is suspected, the use of a tongue depressor to visualize the epiglottis is discouraged. Consequently, the diagnosis is established through indirect fiberoptic laryngoscopy, which is conducted in a controlled environment such as an operating room. A "cherry-red" appearance is ascribed to an infected epiglottis, which is characterized by swelling.

Imaging is rarely beneficial, and treatment should not be postponed in order to conduct this examination.

Epiglottitis Treatment

The most important part of treatment involves securing the airway. Nebulized epinephrine may be useful to improve the situation temporarily.

Epiglottitis may require urgent tracheal intubation to protect the airway. Tracheal intubation can be difficult due to distorted anatomy and profuse secretions. Spontaneous respiration is ideally maintained until tracheal intubation is successful.A surgical airway opening may be required if intubation is not possible.

The management of epiglottitis is different in adults compared to children. Emergent tracheal intubation with general anesthesia (inhalational induction to preserve spontaneous ventilation) in the operating theater is standard. However only 10% of adults require airway intervention, which means a selective approach is required. Tracheal intubation is a high risk scenario with a 1 in 25 failure rate in adults.

Multiple airway management techniques have described for adults and include: awake tracheostomy, awake fibreoptic intubation, general anesthesia with spontaneous breathing preserved or ablated with paralysis.The optimal technique is controversial and likely determined by contextual factors such as the severity of epiglottitis and the clinical location (ie emergency department or intensive care or the operating room). Ideally airway intervention should occur in the operating room with an otolaryngology surgeon present to perform an emergency tracheostomy in the event of complete airway obstruction or failed intubation.

Use Of Corticosteroids

corticosteroids are also typically used.However, there is poor evidence for whether steroids actually improve patient outcomes

Use Of Antibiotics

Intravenous antibiotics such as ceftriaxone and possibly vancomycin or clindamycin are given once the airway is secure. A third-generation cephalosporin such as ceftriaxone is usually sufficient since it is usually effective against H. influenzae and S. pneumoniae. If S. aureus is suspected to be causing the disease, then the treatment should include ceftaroline or clindamycin as these would provide coverage against antibiotic resistant strains of that bacteria.

Vancomycin can also be considered for its MRSA coverage, but it may be less safe than ceftaroline in children older than two months. If the patient has a penicillin allergy, trimethoprim/sulfamethoxazole, clindamycin, or levofloxacin may be appropriate choices.

Also Read Influenza (Flu )Symptoms And Treatment

Epiglottitis is a condition in which the epiglottis, a small cartilage "lid" that envelops the windpipe, expands. The obstruction of airflow into the airways is caused by the enlargement. Epiglottitis has the potential to be life threatening.

Epiglottitis Causes ,signs and symptoms,diagnosis and treatment is briefly discussed below