Epiglottitis

Girish D. Sharma, MD, FCCP

Introduction/Etiology/Epidemiology

•Acute epiglottitis is a potentially life-threatening infection of the supraglottic structures that can lead to sudden fatal airway obstruction if treatment is delayed.

•In a classic case, there is cellulitis of supraglottic structures, particularly the lingual surface of the epiglottis and the aryepiglottic folds. The subglottic space and trachea are usually spared.

•Haemophilus influenzae type b (Hib) is the most commonly cultured organism in children with epiglottitis.

•After the introduction of the Hib vaccine, the incidence of Hib disease among children <5 years of age decreased by 70%, from 37 children per 100,000 in 1989 to 11 children per 100,000 in 1991. By 2000, the annual incidence of invasive Hib in children <5 years decreased by 97% to <1 case per 100,000, with a concomitant dramatic decline in the incidence of acute epiglottitis in children.

•With the decline of Hib disease, epiglottitis is seen more often to be caused by organisms other than Hib, such as Streptococcus pneumoniae and other Streptococcus species, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas species, Candida albicans, Klebsiella pneumoniae, Pasteurella multocida, and Neisseria species.

•Bacterial superinfection of the viral infections also occurs, particularly with herpes simplex, parainfluenza, varicella zoster, and Epstein-Barr virus infections.

•Epiglottitis tends to occur throughout the year; however, in the northern hemisphere, most reported cases occur between December and May.

•Epiglottis tends to occur in children between the ages of 2 and 6 years, although more recently, disease has been reported in much older patients and should be considered at any age.

Clinical Features

•Onset is usually abrupt.

•In some cases, acute symptoms are preceded by minor upper respiratory infection.

•Acute symptoms include abrupt high-grade fever and sore throat; dysphagia may develop over a few hours and is associated with drooling, muffled voice, and respiratory distress.