Epiglottitis, Adult

Basics

Description

  • Rapidly progressive inflammation of the epiglottis and surrounding tissues leading to airway compromise
  • May be more indolent in adults than pediatrics; rapid progression to total airway occlusion still seen in adults
  • Although the incidence of pediatric epiglottitis is decreasing, the incidence in adults is increasing
  • Inflammation of supraglottic structures:
    • Epiglottis:
      • Edema is the primary airway concern
      • May be primary or secondary from adjacent structures
    • Vallecula
    • Arytenoids
  • The source of infection is often the posterior nasopharynx
  • Incidence is 1–4:100,000 adults per yr and rising
  • More common in men: 3:1
  • Adult mortality rate is 7% (<1% in children)
  • Often more severe in these patients:
    • Diabetes
    • BMI >25 kg/m2
    • Concurrent pneumonia
    • Epiglottic cysts
  • Tobacco use and substance abuse are common comorbidities
  • Immunocompromised patients may be particularly fulminant, with minimal associated symptoms and unusual pathogens, such as Candida and Pseudomonas aeruginosa
  • Complications:
    • Total airway obstruction
    • Retropharyngeal abscess
    • Acute respiratory distress syndrome
    • Pneumonia

Etiology

  • Infectious causes:
    • Haemophilus influenzae B, also type A and nontypeable strains
    • Haemophilus parainfluenzae
    • Streptococcus pneumoniae
    • Staphylococcus aureus
    • β-hemolytic streptococcus: Groups A, B, C, F, G
    • Neisseria meningitis
    • Herpes simplex
    • P. aeruginosa
    • Numerous other uncommon agents
    • Most frequently, no causal organism is isolated
  • Physical agents:
    • Chemical and thermal burns
    • Toxic or illicit drug inhalation
  • Trauma, instrumentation

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