Materiały źródłowe

• #1 Epiglottitis (supraglottitis): Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis

  Epiglottitis is most frequently caused by infection, although caustic ingestion, thermal injury, and local trauma are important noninfectious etiologies. Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism. The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor. […] For both infectious and noninfectious etiology, swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids). The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.

• #2 Epiglottitis – Symptoms, Causes, Images, and Treatment Options

  https://www.epocrates.com/online/diseases/452/epiglottitis

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] In children with suspected epiglottitis, no action should be taken that could stimulate them, including examination of the oral cavity, starting intravenous lines, blood draws, or even separation from a parent. Similar caution is required in fulminant acute epiglottitis in adults.

• #3 Epiglottitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227

  Epiglottitis happens when the epiglottis a small cartilage „lid” that covers the windpipe swells. The swelling blocks the flow of air into the lungs. Epiglottitis can be deadly. […] Many factors can cause the epiglottis to swell. These factors include infections, burns from hot liquids and injuries to the throat. […] In the past, a common cause of swelling and inflammation of the epiglottis and surrounding tissues was infection with Haemophilus influenzae type b (Hib) bacteria. Hib is responsible for other conditions, the most common being meningitis. Hib is now much less common in developed countries where children get Hib vaccines. […] In adults, other bacteria and viruses also can cause the epiglottis to swell. […] Rarely, physical injury, such as a blow to the throat, can cause epiglottitis. So can burns from drinking very hot liquids and breathing in smoke from a fire.

• #4 Epiglottitis – Knowledge and References – Taylor & Francis

  https://taylorandfrancis.com/knowledge/Medicine_and_healthcare/Infectious_diseases/Epiglottitis/

  Epiglottitis is an acute inflammation and oedema of the epiglottitis, generally caused by infection with Haemophilus influenza Type B (HIB). The incidence of this condition has decreased rapidly in the UK since the introduction in 1992 of the HIB vaccine to the vaccination schedule for children. […] Epiglottitis is an acute life-threatening inflammatory condition involving the epiglottis and other supraglottic structures. […] Epiglottitis is a feared airway disease defined as inflammation of the epiglottis and surrounding supraglottic structures that commonly presents with fever, pharyngitis, dysphagia, and dyspnea and may progress to life-threatening airway obstruction requiring emergent intubation or tracheostomy.

• #5 Epiglottitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21236

  The most common cause of epiglottitis is a bacterial pathogen. Over 90% of pediatric epiglottitis cases are caused by H influenza type b. However, non-type b H influenza can also cause epiglottitis in vaccinated children. Other known bacterial causes of pediatric epiglottitis include, but are not limited to: Streptococcus pneumoniae, Groups A and C -hemolytic streptococci, Staphylococcus aureus, Moraxella catarrhalis, Haemophilus parainfluenzae, Neisseria meningitidis, Pseudomonas species, Candida albicans, especially in immunocompromised individuals, Klebsiella pneumoniae, Pasteurella multocida, Human immunodeficiency virus (implicated as a potential, rare cause in infants). […] Known organisms that can cause acute epiglottitis or supraglottitis in adults include: H influenzae (25%), H parainfluenza, S pneumoniae, Group A streptococci, Less common bacterial etiologies include mycobacteria, Bacteroides melaninogenicus, Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, K pneumoniae, N meningitis, and P multocida, Less common viral etiologies include herpes simplex viruses Epstein-Barr virus, In immunocompromised patients, Candida and Aspergillus, Community-acquired methicillin-resistant S aureus (rare).

• #6 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/963773-overview

  Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx, with inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds. […] Risk factors for acute epiglottitis, particularly in adults, include diabetes mellitus, ethanol abuse, hyposplenia, autoimmune diseases, immunosuppression, and other causes of impaired defenses of mucosa or against encapsulated organisms. […] In adults, the most common organisms that cause acute epiglottitis are Haemophilus influenzae (25%), followed by H parainfluenzae, Streptococcus pneumoniae, and group A streptococci. […] Noninfectious causes of epiglottitis are not uncommon and produce similar disease. Etiologies include thermal causes (including those associated with crack cocaine smoking and marijuana smoking, as well as throat burns affecting the epiglottis of bottle-fed infants), caustic insults (eg, automatic dishwasher soap ingestion), and foreign body ingestion.

• #7 Epiglottitis – Wikipedia

  https://en.wikipedia.org/wiki/Epiglottitis

  Epiglottitis is primarily caused by an acquired bacterial infection of the epiglottis. Historically it was most often caused by Haemophilus influenzae type B, but with the availability of immunization this is no longer the case. H. influenzae type B contains a capsule which helps it avoid being destroyed by macrophages and also contains surface proteins that allow it to stick to the lining of the upper respiratory tract. Presently, the bacteria most often causing infection are other encapsulated organisms including Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. These bacteria spread in respiratory droplets or aerosols produced from coughing and sneezing. While the overall incidence of epiglottitis has decreased, the incidence of cases caused by Streptococcus pneumoniae has increased in adults. The exact strains of Streptococcus pneumoniae are often those that are covered by the PPV-23 vaccine, but there is no evidence that this vaccine prevents epiglottitis.

• #8 Epiglottitis: Causes, Symptoms, Diagnosis and Treatment

  https://www.webmd.com/a-to-z-guides/epiglottitis-infection-inflammation

  Epiglottitis usually comes from an infection. You’re more likely to get it if you have immune system problems, or if you haven’t had the Hib vaccine. The most common causes are bacteria, including: […] Less often, the infection that leads to epiglottitis can be caused by a fungus, particularly a yeast called Candida albicans or a mold called Aspergillus. That’s more likely in people with immune system problems. […] Sometimes, being sick with a virus allows a bacterial infection to take hold. You might get epiglottitis after you’ve had chickenpox or been infected with herpes simplex or Epstein-Barr. […] If you have epiglottitis, you need to be admitted to the hospital right away. Doctors have to make sure your airway stays open. Treatment includes: […] Doctors will usually give you an antibiotic as soon as possible through a needle placed into a vein, called an IV. They may start with a drug that works on the most common kinds of bacteria. If tests identify which germ is causing the infection, they may change the drug to one specifically targeted to fight that bacteria.

• #9 Epiglottitis (supraglottitis): Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis

  Epiglottitis is most frequently caused by infection, although caustic ingestion, thermal injury, and local trauma are important noninfectious etiologies. Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism. The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor. […] For both infectious and noninfectious etiology, swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids). The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.

• #10 Epiglottitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/epiglottitis/

  Bacteria invades tissue (directly or through hematogenous spreading) of the epiglottis and/or surrounding supraglottic structures (i.e., arytenoids, aryepiglottic folds, and vallecula) supraglottic inflammation and edema narrowing of the airway airway obstruction (partial or complete) […] Most sources recommend monotherapy with a third-generation cephalosporin (e.g., cefotaxime; , ceftriaxone; ); or a beta-lactam with a beta-lactamase inhibitor (e.g., ampicillin/sulbactam , amoxicillin/clavulanate , piperacillin/tazobactam ). […] Consider empiric steroids.

• #11 Epiglottitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Epiglottitis_pathophysiology

  Understading the pathogenesis of epiglottitis involves a good knowlegde of the causative organisms. The only known reservoirs for H. influenzae in humans include, respiratory tract, conjunctival and genital surfaces. Pathogenicity of H. influenza is as a result of imbalance between the virulent factors of the organism and the host immune system. This immunity is enhanced when children are vaccinated with the purified polyribosylribitol phosphate (PRP). H. influenza type b capsule is antiphagocytic. Serum anit-purified polyribosylribitol phosphate (anti-PRP) antibody is important in the complement dependent phagocytosis and lyses of the bacteria. […] Acute epiglottitis pathogenesis is well exemplified by H. influenzae, with the ability to colonize mucosal surfaces and to spread contiguously or invade epithelial cells. It commonly disseminates within the bloodstream, or localizes to selected tissues among these is the epiglottis. Microbial invasion of the bloodstream around the epiglottis leads to inflammatory response and tissue edema most apparent at the lingual surface of the epiglottis compared with the laryngeal surface. The extravasation of fluid leads to remarkable tissue swelling that may lead to respiratory obstruction and the other symptoms of epiglottitis.

• #12 Epiglottitis overview – wikidoc

  https://www.wikidoc.org/index.php/Epiglottitis_overview

  Acute epiglottitis pathogenesis is well exemplified by H. influenzae, with the ability to colonize mucosal surfaces and to spread contiguously or invade epithelial cells. It commonly disseminates within the bloodstream, or localizes to selected tissues among these is the epiglottis. Microbial invasion of the bloodstream around the epiglottis leads to inflammatory response and tissue edema most apparent at the lingual surface of the epiglottis compared to the laryngeal surface. The extravasation of fluid leads to remarkable tissue swelling that may lead to respiratory obstruction and the other symptoms of epiglottitis. […] The pathogenesis of necrotizing epiglottitis involves the infection with CMV or EBV usually in immunocompromised people. Affected patients are usually neutropenic and lymphopenic at presentation. CMV and EBV modulate the host’s immune defense facilitating immune evasion and thereby predisposing the patient to a superimposed infections. The causative organism of necrotizing epiglottitis is unclear.

• #13 Epiglottitis (supraglottitis): Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis

  Epiglottitis is most frequently caused by infection, although caustic ingestion, thermal injury, and local trauma are important noninfectious etiologies. Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism. The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor. […] For both infectious and noninfectious etiology, swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids). The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.

• #14 Epiglottitis Nursing Care Planning and Management

  https://nurseslabs.com/epiglottitis/

  Acute epiglottitis is a rare but potentially life-threatening condition that involves inflammation and swelling of the epiglottis, a small cartilage at the base of the tongue that covers the windpipe during swallowing to prevent food from entering the airway. Epiglottitis can rapidly progress, leading to severe airway obstruction and respiratory distress. […] The epiglottitis becomes inflamed and swollen with edema. […] Hib infection of the epiglottis leads to acute onset of inflammatory edema, beginning on the lingual surface of the epiglottis where the submucosa is loosely attached. […] Swelling significantly reduces the airway aperture. […] Edema rapidly progresses to involve the aryepiglottic folds, the arytenoids, and the entire supraglottic larynx. […] Frank airway obstruction, aspiration of oropharyngeal secretions, or distal mucous plugging can cause respiratory arrest.

• #15 Epiglottitis – TeachMePaediatrics

  https://teachmepaediatrics.com/ent/throat/epiglottitis/

  The epiglottis is a flap of cartilage behind the tongue, designed to protect the larynx during swallowing. […] Haemophilus influenzae and streptococcus pneumoniae are commensal bacteria which may locally invade the epiglottis, resulting in inflammation in 75-90% of cases. Rarely, epiglottitis may be due to non-infectious causes such as trauma or thermal/chemical damage. Inflammation starts on the lingual surface of the epiglottis, before rapidly spreading to other laryngeal structures including the aryepiglottic folds, the arytenoids and supraglottic larynx. The vocal cords have a tightly bound epithelium which restricts progression of the swelling, increasing pressure in a small area and consequently causing airway obstruction. […] Children are at higher risk of acute airway obstruction because of their anatomy. Compared with adults, the epiglottis is much more floppy, broader, longer and angled more obliquely to the trachea. Additionally, their larger tongue and anteriorly-angled vocal cords mean children find it more difficult to move air past even a partial obstruction.

• #16 Epiglottitis (supraglottitis): Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis/print

  Epiglottitis is most frequently caused by infection, although caustic ingestion, thermal injury, and local trauma are important noninfectious etiologies. Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism. […] The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor. Less frequently, noninfectious conditions cause local burns or ecchymosis of the epiglottis and adjacent structures. […] For both infectious and noninfectious etiology, swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids). The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.

• #17 Epiglottitis | Calgary Guide

  https://calgaryguide.ucalgary.ca/epiglottitis/epiglottitis/

  Epiglottitis: Pathogenesis and clinical findings Infectious agent invades the bloodstream and/or the epithelial layer of the epiglottis, aryepiglottic folds and adjacent structures, allowing for spread […] The potential space between the squamous epithelial layer and the epiglottal cartilage fills with inflammatory cells such as neutrophils and eosinophils […] Exudate of inflammatory cells spreads through the lymphatic and blood vessels in the lingual surface of the epiglottis and periepiglottic tissues […] Fluid and inflammatory cells accumulate between the squamous epithelial layer and epiglottal cartilage […] Increased weight and mass of the epiglottis […] Epiglottis curls posteriorly and inferiorly […] Ball-valve effect (Airflow obstructed during inspiration as epiglottis is pulled over airway but not during expiration as epiglottis moves back into position).

• #18 Epiglottitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21236

  Epiglottitis etiologies are primarily infectious; noninfectious etiologies are seen. Noninfectious etiologies can be traumatic, such as thermal injuries, blind-finger sweeps to remove a foreign body from the pharynx, angioneurotic edema, acute leukemia, and hemophagocytic lymphohistiocytosis. Other causes include those associated with smoking crack cocaine or marijuana, throat burns affecting the epiglottis of bottle-fed infants, caustic insults, such as automatic dishwasher detergent ingestion, and foreign body ingestion. Epiglottic swelling may occur in lymphoproliferative diseases. While viruses do not cause epiglottitis, a prior viral infection may allow bacterial superinfection to develop. Viruses that may allow a superinfection include varicella-zoster, herpes simplex, and Epstein-Barr.

• #19 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/763612-overview

  A Taiwanese study by Hsu et al indicated that an association exists between epiglottitis and the autoimmune disease Sjgren syndrome, with the likelihood of finding preexisting Sjgren syndrome in patients with epiglottitis being greater than in controls. […] Noninfectious causes of epiglottitis are not uncommon and produce similar disease. Etiologies include thermal causes (including those associated with crack cocaine smoking and marijuana smoking, as well as throat burns affecting the epiglottis of bottle-fed infants), caustic insults (eg, automatic dishwasher soap ingestion), and foreign body ingestion.

• #20 Epiglottitis (supraglottitis): Clinical features and diagnosis – UpToDate

  https://www.uptodate.com/contents/epiglottitis-supraglottitis-clinical-features-and-diagnosis/print

  Epiglottitis is most frequently caused by infection, although caustic ingestion, thermal injury, and local trauma are important noninfectious etiologies. Infectious epiglottitis is a cellulitis of the epiglottis, aryepiglottic folds, and other adjacent tissues. It results from bacteremia and/or direct invasion of the epithelial layer by the pathogenic organism. […] The posterior nasopharynx is the primary source of pathogens in epiglottitis. Microscopic trauma to the epithelial surface (eg, mucosal damage during a viral infection or from food during swallowing) may be a predisposing factor. Less frequently, noninfectious conditions cause local burns or ecchymosis of the epiglottis and adjacent structures. […] For both infectious and noninfectious etiology, swelling of the epiglottis results from edema and accumulation of inflammatory cells in the potential space between the squamous epithelial layer and the epiglottal cartilage. The lingual surface of the epiglottis and periepiglottic tissues have abundant networks of lymphatic and blood vessels that facilitate spread of infection and the subsequent inflammatory response. Once infection begins, swelling rapidly progresses to involve the entire supraglottic larynx (including the aryepiglottic folds and arytenoids). The subglottic regions generally are not affected; swelling is halted by the tightly bound epithelium at the level of the vocal cords.

• #21 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/963773-overview

  A retrospective study by Suzuki et al indicated that risk factors for severe epiglottitis in adults includes older age, a body mass index of over 25.0 kg/m2, and the presence of diabetes mellitus, epiglottic cyst, or pneumonia, at admission. […] A Taiwanese study by Hsu et al indicated that an association exists between epiglottitis and the autoimmune disease Sjgren syndrome, with the likelihood of finding preexisting Sjgren syndrome in patients with epiglottitis being greater than in controls. […] The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. Most patients can be extubated within several days. However, unrecognized epiglottitis may rapidly lead to airway compromise and resultant death. […] In spite of acute epiglottitis generally having a good prognosis, the risk of death for persons is high due to sudden airway obstruction and difficulty intubating patients with extensive swelling of supraglottic structures.

• #22 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/763612-overview

  Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx, with inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds. […] Direct visualization of the epiglottis using nasopharyngoscopy/laryngoscopy is the preferred method of diagnosis and is replacing radiographic evaluation for suspected epiglottitis. […] Risk factors for acute epiglottitis, particularly in adults, include diabetes mellitus, ethanol abuse, hyposplenia, autoimmune diseases, immunosuppression, and other causes of impaired defenses of mucosa or against encapsulated organisms. […] A retrospective study by Suzuki et al indicated that risk factors for severe epiglottitis in adults includes older age, a body mass index of over 25.0 kg/m2, and the presence of diabetes mellitus, epiglottic cyst, or pneumonia, at admission.

• #23 Epiglottitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227

  Some factors increase the risk of getting epiglottitis, including having a weakened immune system. An immune system weakened by illness or medicines can be more likely to get bacterial infections that may cause epiglottitis. […] Epiglottitis can cause many complications, including breathing failure. The epiglottis is a small, movable „lid” just above the larynx that prevents food and drink from entering the windpipe. Swelling of the epiglottis can completely block the airway. This can lead to breathing or respiratory failure. In this life-threatening condition, the level of oxygen in the blood drops very low.

• #24 Epiglottitis – Wikipedia

  https://en.wikipedia.org/wiki/Epiglottitis

  There have been many cases of epiglottitis reported in immunocompromised patients, including those undergoing cancer treatment and those who are HIV positive. While a variety of different bacteria can cause disease in these patients, cases often involve the Candida species of fungus, though it is unknown if the fungus causes significant disease on its own. […] Alternate risk factors and causes associated with infection include burns and other trauma to the area. Medical research has also identified a link between epiglottitis and crack cocaine usage. Underlying disorders of the immune system, such as graft-versus-host disease and lymphoproliferative disorders, have also been identified as contributors of increased risk for developing the infection.

• #25 Epiglottitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Epiglottitis_pathophysiology

  The H. influenza like other infectious agents cause epiglottis mostly via invasion of the bloodstream by the help of its virulence factors. These include: Capsular polysaccharide, Lipopolysaccharide, Outer-membrane proteins, Pilus proteins, IgA proteases, Histamine, Factors affecting cilial. […] The pathogenesis of necrotizing epiglottitis involves the infection with CMV or EBV usually in immunocompromised people. Affected patients are usually neutropenic and lymphopenic at presentation. CMV and EBV modulate the host’s immune defense facilitating immune evasion and thereby predisposing the patient to superimposed infections. The causative organism of necrotizing epiglottitis is unclear.

• #26 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/963773-overview

  A retrospective study by Suzuki et al indicated that risk factors for severe epiglottitis in adults includes older age, a body mass index of over 25.0 kg/m2, and the presence of diabetes mellitus, epiglottic cyst, or pneumonia, at admission. […] A Taiwanese study by Hsu et al indicated that an association exists between epiglottitis and the autoimmune disease Sjgren syndrome, with the likelihood of finding preexisting Sjgren syndrome in patients with epiglottitis being greater than in controls. […] The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. Most patients can be extubated within several days. However, unrecognized epiglottitis may rapidly lead to airway compromise and resultant death. […] In spite of acute epiglottitis generally having a good prognosis, the risk of death for persons is high due to sudden airway obstruction and difficulty intubating patients with extensive swelling of supraglottic structures.

• #27 Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case–control study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199036

  Studies have revealed that 3.5%26.6% of patients with epiglottitis have comorbid diabetes mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains unclear. […] The results of our large-scale population-based casecontrol study indicate that preexisting DM is one of the possible factors associated with the development of acute epiglottitis. Physicians should pay attention to the symptoms and signs of acute epiglottitis in DM patients, particularly in men aged 3564 years. […] The present study identified a significant association between DM and epiglottitis in patients aged 3564 years, perhaps because patients in this age group tend to be relatively healthy with fewer comorbidities. […] In this study, we identified a significant association between DM and epiglottitis, which may be explained by the altered immunity from depressed polymorphonuclear leukocyte function and decreased leukocyte adherence and phagocytic activity that make the patient more susceptible to acute epiglottitis. […] These findings suggest that underlying DM may play a role in the pathogenesis or pathophysiology of acute epiglottitis, which makes patients with DM more susceptible to acute epiglottitis.

• #28 Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case–control study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199036

  Studies have revealed that 3.5%26.6% of patients with epiglottitis have comorbid diabetes mellitus (DM). However, whether preexisting DM is a risk factor for acute epiglottitis remains unclear. […] The results of our large-scale population-based casecontrol study indicate that preexisting DM is one of the possible factors associated with the development of acute epiglottitis. Physicians should pay attention to the symptoms and signs of acute epiglottitis in DM patients, particularly in men aged 3564 years. […] The present study identified a significant association between DM and epiglottitis in patients aged 3564 years, perhaps because patients in this age group tend to be relatively healthy with fewer comorbidities. […] In this study, we identified a significant association between DM and epiglottitis, which may be explained by the altered immunity from depressed polymorphonuclear leukocyte function and decreased leukocyte adherence and phagocytic activity that make the patient more susceptible to acute epiglottitis. […] These findings suggest that underlying DM may play a role in the pathogenesis or pathophysiology of acute epiglottitis, which makes patients with DM more susceptible to acute epiglottitis.

• #29 Epiglottitis – TeachMePaediatrics

  https://teachmepaediatrics.com/ent/throat/epiglottitis/

  The epiglottis is a flap of cartilage behind the tongue, designed to protect the larynx during swallowing. […] Haemophilus influenzae and streptococcus pneumoniae are commensal bacteria which may locally invade the epiglottis, resulting in inflammation in 75-90% of cases. Rarely, epiglottitis may be due to non-infectious causes such as trauma or thermal/chemical damage. Inflammation starts on the lingual surface of the epiglottis, before rapidly spreading to other laryngeal structures including the aryepiglottic folds, the arytenoids and supraglottic larynx. The vocal cords have a tightly bound epithelium which restricts progression of the swelling, increasing pressure in a small area and consequently causing airway obstruction. […] Children are at higher risk of acute airway obstruction because of their anatomy. Compared with adults, the epiglottis is much more floppy, broader, longer and angled more obliquely to the trachea. Additionally, their larger tongue and anteriorly-angled vocal cords mean children find it more difficult to move air past even a partial obstruction.

• #30 Epiglottitis – Larynx Diseases – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.24.

  Swelling of the upper airway causes airway obstruction in two ways. First, it reduces the airway lumen. Second, it is often associated with thickened secretions and impaired clearance of secretions. Epiglottitis may lead to deep neck space infections or abscesses. These infections can spread through the neck to cause septic thrombophlebitis of the internal jugular vein and inferiorly to cause mediastinitis.

• #31 Epiglottitis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/21236

  Airway obstruction and respiratory arrest can result from inflammatory edema, pooling, aspiration of oropharyngeal secretions, and distal mucus plugging. Bacterial penetration of the mucosal barrier leads to bacteremia, which can spread to surrounding tissues, particularly the supraglottis in adults, and cause infections in the meninges, skin, lungs, ears, and other areas. The loosely attached lingual surface of the epiglottis allows for rapid swelling and airway narrowing, especially in the smaller pediatric larynx. In adults, edema may spread more gradually into the entire supraglottis, while the tightly bound vocal cord epithelium generally prevents its spread to the glottis. […] Infections such as H influenzae can cause significant edema and swelling of the epiglottis and supraglottis, rapidly progressing to airway obstruction in patients of any age. While H influenzae remains the most common pathogen, additional pathogens, including Mycobacterium tuberculosis, must be considered in immunocompromised individuals, though the relative frequencies remain consistent.

• #32 Epiglottitis | Calgary Guide

  https://calgaryguide.ucalgary.ca/epiglottitis/epiglottitis/

  Epiglottitis: Pathogenesis and clinical findings Infectious agent invades the bloodstream and/or the epithelial layer of the epiglottis, aryepiglottic folds and adjacent structures, allowing for spread […] The potential space between the squamous epithelial layer and the epiglottal cartilage fills with inflammatory cells such as neutrophils and eosinophils […] Exudate of inflammatory cells spreads through the lymphatic and blood vessels in the lingual surface of the epiglottis and periepiglottic tissues […] Fluid and inflammatory cells accumulate between the squamous epithelial layer and epiglottal cartilage […] Increased weight and mass of the epiglottis […] Epiglottis curls posteriorly and inferiorly […] Ball-valve effect (Airflow obstructed during inspiration as epiglottis is pulled over airway but not during expiration as epiglottis moves back into position).

• #33 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Bacteria that have colonized the nasopharynx spread locally to cause supraglottic cellulitis with marked inflammation of the epiglottis, vallecula, aryepiglottic folds, arytenoids, and laryngeal ventricles. […] The inflamed supraglottic structures mechanically obstruct the airway, increasing the work of breathing, ultimately causing respiratory failure. Clearance of inflammatory secretions is also impaired. […] Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] A beta-lactamase-resistant antibiotic, such as ceftriaxone, should be used empirically, pending culture and sensitivity test results.

• #34 Epiglottitis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227

  Some factors increase the risk of getting epiglottitis, including having a weakened immune system. An immune system weakened by illness or medicines can be more likely to get bacterial infections that may cause epiglottitis. […] Epiglottitis can cause many complications, including breathing failure. The epiglottis is a small, movable „lid” just above the larynx that prevents food and drink from entering the windpipe. Swelling of the epiglottis can completely block the airway. This can lead to breathing or respiratory failure. In this life-threatening condition, the level of oxygen in the blood drops very low.

• #35 Epiglottitis: Causes, Symptoms, Diagnosis and Treatment

  https://www.webmd.com/a-to-z-guides/epiglottitis-infection-inflammation

  The main complication of epiglottitis is a blocked airway that makes it hard or impossible to breathe. Your body can’t get enough oxygen, which may lead to death. […] The most common cause is a bacterial infection. Symptoms include pain when you swallow and a squeaking sound when you breathe. Epiglottitis is an emergency that needs immediate treatment to keep the swelling from blocking your air supply.

• #36 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  Epiglottitis is a rare inflammatory condition that affects the epiglottis and nearby structures in the upper part of the throat, including the arytenoid soft tissue, aryepiglottic folds, valleculae, base of the tongue, soft palate, and uvula. […] Epiglottitis etiologies, such as Haemophilus influenza type b, are primarily infectious, including bacterial infections following a recent viral illness. Noninfectious etiologies include direct trauma, angioneurotic edema, or acute leukemia. […] While protocols for treating epiglottitis airway emergencies in children have been established, a consensus on the optimal management of the condition in adults, particularly regarding the timing and necessity of airway intervention, has not been reached. […] Airway obstruction and respiratory arrest can result from inflammatory edema, pooling, aspiration of oropharyngeal secretions, and distal mucus plugging. Bacterial penetration of the mucosal barrier leads to bacteremia, which can spread to surrounding tissues, particularly the supraglottis in adults, and cause infections in the meninges, skin, lungs, ears, and other areas. […] Infections such as H influenzae can cause significant edema and swelling of the epiglottis and supraglottis, rapidly progressing to airway obstruction in patients of any age.

• #37 Epiglottitis – Larynx Diseases – Respirology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.3.24.

  Swelling of the upper airway causes airway obstruction in two ways. First, it reduces the airway lumen. Second, it is often associated with thickened secretions and impaired clearance of secretions. Epiglottitis may lead to deep neck space infections or abscesses. These infections can spread through the neck to cause septic thrombophlebitis of the internal jugular vein and inferiorly to cause mediastinitis.

• #38 Epiglottitis – Core EM

  https://coreem.net/core/epiglottitis/

  An acute infection and inflammation of the supraglottic soft tissue structures, which can lead to airway occlusion over a relatively short period of time, typically 2-7 days. Because of the possibility for rapid decompensation to airway occlusion, this is considered an ENT emergency. […] Due to the success of the Hib vaccine in decreasing the incidence of pediatric illness, epiglottitis now mainly affects adults, and its initial presentation is usually more subacute. […] Epiglottitis is difficult to diagnose, and some studies have estimated that it is missed on initial presentation as much as 80% of the time. The initial symptoms of epiglottitis may be identical to a viral URI or strep throat, but can progress to airway compromise over a relatively short period of time. […] For patients with advanced inflammation, prophylactic intubation may be necessary. Involve consultants early for a possible awake intubation in the OR, and with preparations to convert to a surgical airway, if necessary. […] Epiglottitis has demonstrated a resurgence in the adult population. It is no longer a pediatric only disease. […] Definitive diagnosis is made by flexible fiberoptic laryngoscopy.

• #39 Epiglottitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/452

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected. […] Once the airway has been secured and antibiotics have been initiated, the condition usually resolves rapidly. […] Vaccination does not preclude the possibility of epiglottitis or even the possibility of epiglottitis from Haemophilus influenzae. […] Epiglottitis is an infection of the supraglottis with the potential to cause airway compromise, due to inflammation and swelling, and should be treated as a surgical emergency until the airway is examined and secured.

• #40 Epiglottitis – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/oral-and-pharyngeal-disorders/epiglottitis

  Bacteria that have colonized the nasopharynx spread locally to cause supraglottic cellulitis with marked inflammation of the epiglottis, vallecula, aryepiglottic folds, arytenoids, and laryngeal ventricles. […] The inflamed supraglottic structures mechanically obstruct the airway, increasing the work of breathing, ultimately causing respiratory failure. Clearance of inflammatory secretions is also impaired. […] Diagnosis requires direct examination, usually with flexible fiberoptic laryngoscopy. […] Direct laryngoscopy that reveals a beefy-red, stiff, edematous epiglottis is diagnostic. […] A beta-lactamase-resistant antibiotic, such as ceftriaxone, should be used empirically, pending culture and sensitivity test results.

• #41 Epiglottitis/Supraglottitis — Headmirror

  https://www.headmirror.com/epiglottitis

  Epiglottitis is defined by acute inflammation of the epiglottis and surrounding supraglottis associated with infection (majority of cases), thermal or chemical inhalation, caustic ingestion or foreign bodies. […] In adults, the incidence has remained stable with common isolated pathogens including Haemophilus influenzae, Streptococcus pyogenes and pneumoniae, Staphylococcus aureus, and rarely Candida species in immunosuppressed patients. […] The clinical triad of the three Ds (drooling, dysphagia, and distress) constitutes the classic presentation of epiglottitis in both adults and children. […] Lateral neck X-ray to assess epiglottis thickness (i.e., thumb sign) is sometimes used as a screening tool in the ER setting. […] For children, laryngeal examination via nasopharyngeal endoscopy or direct laryngoscopy in the OR is required for diagnosis but ideally should take place with preparations for securing an airway.

• #42 Epiglottitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/452

  Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. […] Diagnosis is made on clinical grounds, and laboratory or other interventions should not preclude or delay timely control of the airway if epiglottitis is suspected. […] Vaccination does not preclude the possibility of epiglottitis or even the possibility of epiglottitis from Haemophilus influenzae. […] Epiglottitis is an infection of the supraglottis that has the potential to cause airway compromise, due to inflammation and swelling, and should be treated as a surgical emergency until the airway is examined and secured.

• #43 Epiglottitis – Combat Medicine 101

  https://combatmedicine101.com/epiglottitis/

  Epiglottitis occurs when the epiglottis becomes infected and inflamed, potentially causing life-threatening airway obstruction. […] In the post-Hib-vaccine era, Streptococcus and Staphylococcus are now the leading causes of epiglottitis. […] Powerful broad-spectrum antibiotics like Ceftriaxone and Amoxicillin/clavulanic acid are essential for the rapid elimination of bacteria causing epiglottitis. […] The use of steroids like Dexamethasone is controversial in cases of epiglottitis, but the idea is that the steroids would help reduce the inflammation of the epiglottis and aid in recovery. […] In cases of epiglottitis, we have to be particularly careful not to disturb the epiglottis. […] The majority of patients with acute epiglottitis typically recover without residual airway or other problems if the airway is promptly secured and appropriate antimicrobial therapy is administered.

• #44 Epiglottitis/Supraglottitis — Headmirror

  https://www.headmirror.com/epiglottitis

  While many cases present early and can be managed with IV antibiotics, steroids, and close airway monitoring, delayed presentation in adults or children may require emergent intubation or a surgical airway. […] Consequently, upon consultation, the first step is to assess the status of the airway and ensure NPO status, as rapid disease progression may require rapid action to secure the airway. […] Once diagnosed, antibiotic treatment is highly effective, and inflammation generally resolves within a few days.

• #45 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430960/

  No consensus exists on the optimal management of adult epiglottitis due to varying clinical presentations, healthcare settings, expertise, and resources. […] Successful treatment across all ages requires rapid, accurate diagnosis, proper identification of patients needing immediate airway control, anticipation of deterioration, and preparedness for front-of-neck airway access.

• #46 Epiglottitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK430960/

  Infections such as H influenzae can cause significant edema and swelling of the epiglottis and supraglottis, rapidly progressing to airway obstruction in patients of any age. While H influenzae remains the most common pathogen, additional pathogens, including Mycobacterium tuberculosis, must be considered in immunocompromised individuals, though the relative frequencies remain consistent. […] No consensus exists on the optimal management of adult epiglottitis due to varying clinical presentations, healthcare settings, expertise, and resources. Pediatric epiglottitis may be more straightforward to manage than adult cases, but successful treatment across all ages requires rapid, accurate diagnosis, proper identification of patients needing immediate airway control, anticipation of deterioration, and preparedness for front-of-neck airway access.

• #47 Epiglottitis: Practice Essentials, Etiology, Epidemiology

  https://emedicine.medscape.com/article/963773-overview

  A retrospective study by Suzuki et al indicated that risk factors for severe epiglottitis in adults includes older age, a body mass index of over 25.0 kg/m2, and the presence of diabetes mellitus, epiglottic cyst, or pneumonia, at admission. […] A Taiwanese study by Hsu et al indicated that an association exists between epiglottitis and the autoimmune disease Sjgren syndrome, with the likelihood of finding preexisting Sjgren syndrome in patients with epiglottitis being greater than in controls. […] The prognosis in adults with acute epiglottitis is good with appropriate and timely treatment. Most patients can be extubated within several days. However, unrecognized epiglottitis may rapidly lead to airway compromise and resultant death. […] In spite of acute epiglottitis generally having a good prognosis, the risk of death for persons is high due to sudden airway obstruction and difficulty intubating patients with extensive swelling of supraglottic structures.

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