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Epiglottitis

Supraglottitis

Epiglottitis is inflammation of the epiglottis. This is the tissue that covers the trachea (windpipe). Epiglottitis can be a life-threatening disease.

Causes

The epiglottis is a stiff, yet flexible tissue (called cartilage) at the back of the tongue. It closes your windpipe (trachea) when you swallow so food does not enter your airway. This helps prevent coughing or choking after swallowing.

In children, epiglottitis is usually caused by the bacteria Haemophilus influenzae (H. influenzae) type B. In adults, it is often due to other bacteria such as Strepcoccus pneumoniae, or viruses such as herpes simplex virus and varicella-zoster.

Epiglottitis is now very uncommon because the H. influenzae type B (Hib) vaccine is given routinely to all children. The disease was once most often seen in children ages 2 through 6. In rare cases, epiglottitis can occur in adults.

Symptoms

Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

  • Abnormal breathing sounds (stridor)
  • Fever
  • Blue skin color (cyanosis)
  • Drooling
  • Difficulty breathing (the person may need to sit upright and lean slightly forward to breathe)
  • Difficulty swallowing
  • Voice changes (hoarseness)

The airways can become totally blocked, which can result in cardiac arrest and death.

Exams and Tests

Epiglottitis can be a medical emergency. Seek medical help right away. Do not use anything to press the tongue down to try to look at the throat at home. Doing so may make the condition worse.

The health care provider may examine the voice box (larynx) using a small mirror held against the back of the throat. Or a viewing tube called a laryngoscope may be used. This examination is best done in the operating room or a similar setting where sudden breathing problems can be more easily handled.

Tests that may be done include:

Treatment

A hospital stay is needed, usually in the intensive care unit (ICU).

Treatment involves methods to help the person breathe, including:

  • Breathing tube (intubation)
  • Moistened (humidified) oxygen

Other treatments may include:

  • Antibiotics to treat the infection
  • Anti-inflammatory medicines, called corticosteroids, to decrease throat swelling
  • Fluids given through a vein (by IV)

Outlook (Prognosis)

Epiglottitis can be a life-threatening emergency. With proper treatment, the outcome is usually good.

When to Contact a Medical Professional

Spasm may cause the airways to close suddenly. Or, the airways may become totally blocked. Either of these situations could result in death.

Prevention

The Hib vaccine protects most children from epiglottitis.

The most common bacteria (H. influenza type b) that causes epiglottitis is easily spread. If someone in your family is sick from this bacteria, other family members need to be tested and treated.

References

Nayak JL, Weinberg GA. Epiglottitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 64.

Roosevelt GE. Acute inflammatory upper airway obstruction (croup, epiglottitis, laryngitis, and bacterial tracheitis). In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 385.

  • Haemophilus influenza organism

    Haemophilus influenza organism - illustration

    This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)

    Haemophilus influenza organism

    illustration

  • Throat anatomy

    Throat anatomy - illustration

    Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

    Throat anatomy

    illustration

  • Haemophilus influenza organism

    Haemophilus influenza organism - illustration

    This is a Gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenza, one of the most common causes of childhood meningitis (prior to the widespread use of the H influenza vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenza (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4, and 12 months.

    Haemophilus influenza organism

    illustration

    • Haemophilus influenza organism

      Haemophilus influenza organism - illustration

      This picture shows the organism Haemophilus influenza. Infections caused by Haemophilus influenza usually occur in children under 6 years old and are extremely serious. Haemophilus (type B) is responsible for meningitis, periorbital cellulitis, buccal cellulitis and epiglottitis, septic arthritis, osteomyelitis, pericarditis, and bacteremia. The small organisms live within cells (intracellular) as shown in this picture. (Image courtesy of the Centers for Disease Control and Prevention.)

      Haemophilus influenza organism

      illustration

    • Throat anatomy

      Throat anatomy - illustration

      Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

      Throat anatomy

      illustration

    • Haemophilus influenza organism

      Haemophilus influenza organism - illustration

      This is a Gram stain of spinal fluid from a person with meningitis. The rod-like organisms seen in the fluid are Haemophilus influenza, one of the most common causes of childhood meningitis (prior to the widespread use of the H influenza vaccine). The large red-colored objects are cells in the spinal fluid. A vaccine to prevent infection by Haemophilus influenza (type B) is available as one of the routine childhood immunizations (Hib), typically given at 2, 4, and 12 months.

      Haemophilus influenza organism

      illustration

     

    Review Date: 3/15/2018

    Reviewed By: Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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