Epiglotitis por Haemophilus influenzae tipo b en la era de la vacunación: caso clínico pediátrico / Epiglottitis due to Haemophilus influenzae type b in the vaccination era: pediatric clinical case

La epiglotitis aguda infecciosa es infrecuente en la actualidad, debido a la vacunación contra su principal agente etiológico, el Haemophilus influenzae b. Se requiere alto índice de sospecha ante el cuadro clínico de dificultad respiratoria, estridor, disfonía y fiebre. Se presenta a un niño de 2 años, previamente sano, con esquema de vacunas completas, con dificultad respiratoria aguda y estridor laríngeo, en el que, al momento de realizar la intubación, se realizó el diagnóstico de epiglotitis aguda. Con hemocultivos positivos para Haemophilus influenzae b, cumplió 13 días de tratamiento con ceftriaxona, con hemocultivos de control y cultivo de líquido cefalorraquídeo negativo.

Acute infectious epiglottitis is infrequent at present due to vaccination for its main etiologic agent, Haemophilus influenzae b (Hib). It must be taken into account when we make a differential diagnosis in a child whose clinical symptoms are respiratory distress, stridor, dysphonia and fever. We report a 2-year-old child, previously healthy, whose vaccination calendar was complete, and whose clinical presentation included respiratory distress and stridor; at the moment of the intubation the laryngoscopy showed an acute epiglottitis. Blood cultures were taken, which were positive for Hib. He was treated with ceftriaxone during 13 days, and the control blood cultures and cerebrospinal fluid were negative.

A Clinical Study of Acute Epiglottitis: Retrospective Review of 315 Patients in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a life-threatening condition that can result in airway obstruction. The present study reports clinical features, management and patient outcomes in an acute epiglottitis. SUBJECTS AND METHOD: Included in our retrospective study were 315 patients who were admitted with the diagnosis of acute epiglottitis between January 2006 and July to the department Otolaryngology-Head and Neck surgery, Hallym University Sacred Heart Hospital 2018. The diagnosis of acute epiglottitis was established by confirmation of inflamed epiglottis using laryngoscope or computed tomography. RESULTS: Among 315 patients, 89 cases (28%) and 83 cases (26%) were found in the fifth and fourth decades, respectively. The mean age of patients was 45.0±13.94 years. The male to female ratio was 1.33:1. A total of 75 patients (23.8%) had co-morbidities, with hypertension (13.6%) being the most common. Fever was relatively uncommon, whereas most patients complained of sore throat. Ceftriaxone was the most common empirical antibiotic regimen prescribed and the use of steroids did not affect the length of hospital stay. Nine patients required airway intervention, including eight who underwent endotracheal intubation and one emergency tracheostomy. In patients who need airway intervention, systolic blood pressure, body temperature, respiratory rate, heart rate, white blood cells and the proportion of dyspnea were significantly higher in comparison to the patients without airway intervention. CONCLUSION: Although acute epiglottitis often has nonspecific symptoms, it may lead to sudden dyspnea and unstable vital signs, so an in-depth understanding of this disease is needed.

An analysis of prognosis risk factors in sever acute epiglottitis / 中华急诊医学杂志

Objective To confirm the risk factors of poor prognosis in patients with severe acute epiglottitis by comparing symptoms and results of laboratory tests.Methods A total of 698 patients with acute epiglottitis from outpatient and emergency room from 1995 to 2014 were retrospectively studied.These patients were divided into severe or mild group as per the means of treatment of airway including invasive (n =115)and non-invasive (n =583).The past history,general conditions and laboratory tests were compared between the two groups by chi-square or t test;the spearman correlation between the degree of dyspnea and epiglottis edema was analyzed,and the risk factors of poor prognosis were detected by logistic regression.Results The ratio of male to female was 1.366/1.There was a high prevalence of sever acute epiglottitis in spring,winter and at night, respectively.More smokers were found in the severe group compared with the mild group (χ2 =41.957,P <0.01).Severe dyspnea and low PaO2 (r =0.573,P <0.01),but not the poor grading of epiglottis edema evaluated by pharyngo-fiberoscope (r =-0.024,P =0.525),were correlated with poor prognosis.Male (OR =1.84,95%CI:1.41 -3.22,P =0.001),an attack at night (OR =2.61,95%CI:1.98 -3.16),P =0.07), smoker (OR =1.63,95%CI:1.05 -3.39,P =0.04)and low PaO2 (OR =2.97,95%CI:1.58 -4.49,P =0.02)were independent risk factors for a poor prognosis.Conclusions Male,an attack at night,smoker and low PaO2 were independent risk factors for a poor prognosis of acute epiglottitis.A critical care should be given to patients with those risk factors,even their epiglottis edema was not very serious.

Adult acute epiglottitis: An eight - year experience in a Philippine tertiary government hospital

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To review cases of adult acute epiglottis in a tertiary government hospital and describe the clinical presentations, diagnostics performed, management and outcomes. <br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective Chart Review<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Participants:</strong> Records of patients admitted by or referred to the Department of Otolaryngology Head and Neck Surgery with a diagnosis of acute epiglottis from January 2008 to August 2014 were identified from the department census and charts were retrieved from the Hospital Record Section and evaluated according to inclusion and exclusion criteria. Information regarding demographic data, clinical features, laboratory and other diagnostic examinations, medical management, and length of hospital stay were collected.<br /><strong>RESULTS:</strong> There were 20 cases in 7 years and 8 months. Most were male, 18 to 37-years-old, presenting with dysphagia, odynophagia and a swollen epiglottis on laryngoscopy. Abnormal soft-tissue lateral radiographs of the neck and leukocytosis were seen in 73% and 83%, respectively. Intravenous antibiotics and corticosteroids were administered in all cases, and mean hospital stay was 11.2 days.<br /><strong>CONCLUSION:</strong> Adult acute epiglottis should be highly suspected in patients presenting with dysphagia, odynophagia, and muffling of the voice even with a normal oropharyngeal examination. History of respiratory infection, co-morbidities, smoking and alcohol intake, concomitant laryngeal pathology and supraglottic structure insults contribute to development of the disease. Laryngoscopy is still the gold standard in diagnosis. Airway protection is mandatory but prophylactic intubation or tracheostomy are not advised. Intravenous antibiotics are necessary and corticosteroids may be of benefit. </p>

Clinical Features of Acute Epiglottitis in Adults in the Emergency Department

PURPOSE: Acute epiglottitis is a potentially fatal condition that can result in airway obstruction. The aim of this study is to examine the clinical features of adult patients who visited the emergency department (ED) with acute epiglottitis. METHODS: This retrospective observational study was conducted at a single tertiary hospital ED from November 2005 to October 2015. We searched our electronic medical records (EMR) system for a diagnosis of "acute epiglottitis" and selected those patients who visited the ED. RESULTS: A total of 28 patients were included. There was no pediatric case with acute epiglottitis during the study period. The mean age of the patients was 58.0+/-14.8 years. The peak incidences were in the sixth (n=7, 25.0%) and eighth (n=8, 28.6%) decades. The male-to-female ratio was 2.1:1. The most common symptom was sore throat (n=23, 82.1%), followed by dyspnea (n=15, 53.6%), hoarseness (n=7, 25.0%), fever (n=6, 21%), and dysphagia (n=5, 17.9%). The diagnosis of acute epiglottitis was confirmed when edema and hyperemia of the epiglottis were visualized by laryngoscopy. Twenty-six patients were treated conservatively with antibiotics and steroids without definite airway management. Two patients were intubated, but no patients required tracheostomy. CONCLUSION: In adult patients with acute epiglottitis, sore throat and dyspnea were the most common symptoms but fever was infrequent. Most patients improved with conservative management only. Definite airway management was required in only two patients in whom endotracheal intubations were performed successfully in the ED by emergency physicians, and surgical airway management was not required.

An Adult With Thumb Sign In The Lateral Neck Radiograph

Acute epiglottitis though relatively common in pediatric patients as compared to adults, present with almost similar clinical presentations. They include voice change, difficulty or painful swallowing and sometimes with upper airway obstruction. Physical finding of swollen epiglottis is difficult to be obtained owing to the danger of introducing laryngeal mirror into the oropharynx as to avoid contact spasm. The diagnostic thumb sign appearance on lateral neck radiograph is considered pathognomonic of epiglottitis. We report a case of an adult with clinical features and radiological finding of an acute epiglottitis, which did not resolve with antibiotic treatment. Subsequent imaging confirmed the presence of an abscess in the epiglottic mucosa.

Sudden Death from Acute Epiglottitis and Epiglottic Abscess in Adult / 대한법의학회지

Acute epiglottitis is an inflammation of the epiglottis and adjacent structures. Although the incidence is extremely rare, acute epiglottitis is a life-threatening medical emergency and can cause sudden respiratory obstruction. Herein, we describe two cases of sudden death from epiglottitis and epiglottic abscess. A 39-year-old man and 66-year-old man died after suffering from shortness of breath. Autopsies revealed diffuse swelling and abscess formation in the epiglottis and neighboring structures. These cases emphasize the medicolegal importance of sudden death from acute epiglottitis and epiglottic abscess in adults.

Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea / 소아과

PURPOSE: Croup is a common pediatric respiratory illness with symptoms of varying severity. Moreover, epiglottitis is a rare disease that can rapidly progress to life-threatening airway obstruction. Although the clinical course and treatments differ between croup and epiglottitis, they are difficult to differentiate on presentation. We aimed to compare the clinical characteristics of croup and epiglottitis in Emergency Department patients. METHODS: The 2012 National Emergency Department Information System database of 146 Korean Emergency Departments was used to investigate patients aged < or =18 years presenting with croup or epiglottitis. RESULTS: We analyzed 19,374 croup patients and 236 epiglottitis patients. The male:female sex ratios were 1.9:1 and 2.3:1 and mean ages were 2.2+/-2.0 and 5.6+/-5.8 years, respectively. The peak incidence of croup was observed in July and that of epiglottitis was observed in May. The hospitalization rate was lower in croup than in epiglottitis patients, and the proportion of patients treated in the intensive care unit was lower among croup patients. The 3 most common chief complaints in both croup and epiglottitis patients were cough, fever, and dyspnea. Epiglottitis patients experienced dyspnea, sore throat, and vomiting more often than croup patients (P<0.05). CONCLUSION: Both groups had similar sex ratios, arrival times, 3 most common chief complaints, and 5 most common comorbidities. Epiglottitis patients had a lower incidence rate, higher mean age of onset, and higher hospitalization rate and experienced dyspnea, sore throat, and vomiting more often than croup patients. Our results may help in the differential diagnosis of croup and epiglottitis.

Fatal Inhalation Injury by Sulfuric Acid Fumes: Case Report / 대한법의학회지

Sulfuric acid can cause local or systemic effects after exposure by inhalation, ingestion, or topical application. Direct ingestion is the main exposure route for fatal sulfuric acid injury. Fatal accidents involving the inhalation of toxic sulfuric acid vapors are rare. Inhalation of sulfuric acid fumes causes severe irritation or corrosive damage to the upper respiratory tract. Consequently, severe congestion, edema, and inflammation of the mucous membranes of the upper respiratory passages hinder the entry of air into the lungs, possibly leading to fatalities in victims. A 35-year-old man died at his home after complaining of a severe sore throat. One day earlier, he had worked in a sulfuric acid tank in a copper-smelting plant while wearing an ordinary gas mask that offered no protection against sulfurous acid vapors. Upon autopsy, the larynx and epiglottis showed pronounced edema, congestion, and inflammation that histologically mimicked an acute bacterial suppurative inflammation, accompanied by severe pulmonary edema. A field analysis of the air inside the sulfuric acid tank revealed SO4(2-) positivity and a 40% sulfuric acid concentration.

Predicting the Airway Patency using the Parameters of Soft-tissue Lateral Neck Radiography in Adult Patients with Acute Epiglottitis

PURPOSE: We wanted to predict the high risk group that requires urgent airway intervention by using the parameters of the soft-tissue lateral neck radiographs of adult acute epiglottitis patients. METHODS: This retrospective study was conducted in two teaching hospitals. The patients who were diagnosed with acute epiglottitis from June, 2007 to May, 2009 were enrolled and their medical records and x-ray films were reviewed. The width of the epiglottis at the widest point (EW), the width of the arytenoid at the widest point (AW), the prevertebral soft tissue distance at the third cervical spine (PSTD), the shortest distance from the epiglottis to the hypopharyngeal wall (EHD) and the shortest distance from the epiglottic root to the arytenoids'tip (EAD) were investigated and we performed regression analyses of these parameters of the patients in the high risk group that required urgent airway intervention. RESULTS: A total of 42 patients were enrolled. Dyspnea and hoarseness were more frequent in the high risk group that required urgent airway intervention (p=0.008, 0.040, respectively). The EW was significantly longer (p=0.001) in the high risk group. The EHD and EAD were significantly shorter (p=0.012, <0.001, respectively) in the high risk group. Only the EAD showed significant correlation with the percent of airway patency on linear regression analysis (p=0.003) and the EAD was the only significant predictor for the high risk group on multivariate logistic regression analysis (p=0.043). The receiver operating characteristics curve of the EW/EAD for the high risk group was obtained and it showed the best predictive power (AUC: 0.977, p<0.001). CONCLUSION: The EAD noted on soft-tissue lateral neck radiography is an important predictor of high risk patients who require urgent airway intervention. The cut-off value of the EW/EAD for the predicting the high risk group is 2.44 (sensitivity 100%, specificity 85.7%).

Sudden death due to epiglottic abscess / 대한법의학회지

Acute epiglottitis is a local bacterial infection of the supraglottic area. Epiglottitis is generally caused by organisms which invoke an inflammatory response that develops rapid obstructive edema. The disease rarely progresses to abscess stage, either because medical intervention is sought or death by asphyxiation ensues. A 38-year-old, mentally ill but physically healthy woman died of airway obstruction caused by acute epiglottitis forming an abscess. She died unexpectedly and suddenly showing only minor nonspecific symptoms.

Three Cases of Scrub Typhus with Acute Epiglottitis / 감염과화학요법

Scrub typhus is an endemic rickettsial disease with annual seasonal outbreak in Korea and its incidence is increasing. Recently, cases of scrub typhus with severe complications, such as septic shock, acute respiratory distress syndrome, acute renal failure, myocarditis, disseminated intravascular coagulation and meningitis have been increasingly reported. Acute epiglottitis is the one of potentially life- threatening scrub typhus related complications. Its initial clinical manifestations are sore throat, dysphagia or dyspnea. Although 22-62% of scrub typhus patients complain of sore throat, the etiology and optimal therapy are not yet known. We experienced 3 cases of scrub typhus-associated acute epiglottitis which rapidly responded to short-term corticosteroid administration.

Three Cases of Scrub Typhus with Acute Epiglottitis / 감염과화학요법

Scrub typhus is an endemic rickettsial disease with annual seasonal outbreak in Korea and its incidence is increasing. Recently, cases of scrub typhus with severe complications, such as septic shock, acute respiratory distress syndrome, acute renal failure, myocarditis, disseminated intravascular coagulation and meningitis have been increasingly reported. Acute epiglottitis is the one of potentially life- threatening scrub typhus related complications. Its initial clinical manifestations are sore throat, dysphagia or dyspnea. Although 22-62% of scrub typhus patients complain of sore throat, the etiology and optimal therapy are not yet known. We experienced 3 cases of scrub typhus-associated acute epiglottitis which rapidly responded to short-term corticosteroid administration.

Budesonide in the treatment of acute epiglottitis / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the curative effect of budesonide on acute epiglottitis. METHODS Seventy-eight patients with acute epiglottitis were devided into 2 groups randomly. Budesonide and dexamethasone were breathed in respectively with other treatments being the same. The results were processed statistically. RESULTS The effective and apparent effective rate were 98 % and 95 % in the experimental group,81 % and 72 % in control group. The effective rate was significantly different between the 2 groups,the apparent effective rate was very significantly different between the 2 groups. CONCLUSION The budesonide is more powerful than dexamethasone in the treatment of acute epiglottitis. It can decrease the epiglottis edema more quickly and reduce the opportunity of tracheotomy.

Acute Epiglottitis in Adults: A Review of 85 Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. The incidence of acute epiglottitis in children has declined with introduction of the Haemophilus influenza type b vaccine. However, there have been few reports about acute epiglottitis in adults up until now. The aim of this study was to assess clinical characteristics of adult cases of acute epiglottitis. SUBJECTS AND METHOD: We retrospectively reviewed 85 hospitalized adult patients who had been admitted to the Department of Otolaryngology-Head and Neck surgery, Korea University Hospital from January 1998 to December 2002, and diagnosed with acute epiglottitis. RESULTS: Among the 85 patients, 23 cases (27%) and 24 cases (28%) were found in fourth and sixth decades of age, respectively. The male-to-female ratio was 1.6:1. Monthly distribution showed that 12 cases (14%) were in March and 11 (13%) in July. The most common symptom was in the order of throat pain (78%). Others were dysphagia (68%), voice change (67%) and dyspnea (42%). All patients were treated with antibiotics and steroids. About a half of all cases (54%) were hospitalized for 4 to 5 days. Tracheostomy was performed in 2 patients and orotracheal intubation in one patient. CONCLUSION: Throat pain and dysphagia were most common symptoms of acute epiglottitis. In most cases, therapies using intravenous antibiotics and short-term steroid were effective, but otolaryngologist must also suspect the possibility of sudden upper airway obstruction. We experienced emergency situations regarding airway obstruction in only three cases during the first week of hospitalization.

A Case of Empyema and Retropharyngeal Abscess Complicated by Acute Epiglottitis / 감염

After the introduction of antibiotics, empyema is a rare complication of retropharyngeal abscess caused by acute epiglottitis. But once it occurs, it may be a fatal outcome. Retropharyngeal abscess may spread to mediastinum and pleural cavity along the deep cervical fascia, then it can induce pneumonia, mediastinitis, empyema, and sepsis. Because of its fatal complication, early diagnosis and intensive surgical treatment, such as incision and drainage, is necessary. Now we have a experience of empyema caused by retropharyngeal abscess in a 56-year old diabetic patient with nephropathy. He was admitted to our hospital because of hoarseness and sore throat due to acute epiglottitis. Several days after his admission, he complained of swelling of neck, which was diagnosed as retropharyngeal abscess by the computerized tomography. Retropharyngeal abscess was managed with antibiotics, incision and drainage and culture revealed Peptostreptococcus prevotii. Subsequently empyema developed in his right chest, which was managed with closed thoracotomy, though, he expired due to progression of sepsis.

Acute epiglottitis

1. Fifteen cases of acute primary epiglottitis were reviewed2. Young and middle-aged males are more susceptible to the disease than others3. Scarification and incision are the best therapeutic measures because they give relief promptly4. The average duration of hospitalization is 7 days5. Sulfadiazine given together with penicillin shorten the course of the disease to about 4 to 5 days. (Summary and Conclusions)

Two Cases of Epiglottitis Caused by Haemophilus Influenzae Type b Infection / 소아알레르기및호흡기학회지

Epiglottitis is an uncommon but potentially life threatening infectious disease in young children. And it is rapidly progressing cellulitis of the epiglottis and adjacent structures that has the potential for causing abrupt, complete airway obstruction. The most common cause of acute epiglottitis is Haemophilius influenzae type b(Hib), therefore in USA, the acute epiglottitis is seen less commonly since the wide spread use of immunization against Hib. In Korea, there has been no report of acute epiglottitis caused by known bacterial organism, and a little investigation of the effects of the immunization against Hib, or Hib related respiratory diseases. In this report, we describe two cases of acute epiglottitis caused by Hib, occurred in non-immunized young-male children admitted to Ajou University Hospital. They had visited to the emergency center of Ajou University hospital with the complaints of acute fever, drooling, dysphagia and severe respiratory difficulties. In both cases, we observed the cherry-red colored, severely swollen epiglottis by the direct laryngoscopic examination. Hib was cultured in blood samples from both two cases, and the patients treated successfully by the 3 days of endotracheal intubation and proper antibiotics therapy without any complications such as pneumonia, meningitis, osteomyelitis, or pericarditis.

Two Cases of Acute Epiglottitis with Sitting up Position, Chin Thrust Forward, Having Dyspnea / 결핵

Acute epiglottitis is a life threatening inflammatory disease of the upper airway mainly in children, however, the recent reports about acute epiglottitis in adults are increasing. The common symptoms are sore throat, dysphagia, dyspnea and salivary drooling. As the laryngeal edema progresses, the patient sits up, leans forward, with the chin thrust forward, having obvious difficulty breathing. Early recognition and proper airway maintenance until the inflammatory edema subsides are essential steps to avoid a possible life threatening upper airway obstruction. We experienced two cases of acute epiglottitis with sitting up position, chin thrust forward, having dyspnea.