Epiglottitis overview: Difference between revisions
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==Causes== | ==Causes== | ||
Prior to the introduction of [[Haemophilus Influenzae B|Haemophilus]] influenza type b vaccine,<ref name="Sch20152">{{cite book|last1=Schlossberg|first1=David|title=Clinical infectious disease|date=2015|isbn=9781107038912|page=202|edition=Second|url=https://books.google.ca/books?id=meFwBwAAQBAJ&pg=PA202}}</ref> [[Haemophilus influenzae|H. influenza]] was the most common culprit of [[epiglottitis]]. In recent literature, group A [beta]-hemolytic [[Streptococcus|Streptococci]] is more commonly observed to be the cause. The disease used to be mostly found in pediatric age group of 3 to 5 years. However, recent trend favors adults as most commonly affected individuals.<ref name="pmid27031010">{{cite journal| author=Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED| title=Epiglottitis: It Hasn't Gone Away. | journal=Anesthesiology | year= 2016 | volume= 124 | issue= 6 | pages= 1404-7 | pmid=27031010 | doi=10.1097/ALN.0000000000001125 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27031010 }} </ref> Other pathogens such as ''[[escherichia coli]]'', ''[[candida albicans]]'', or ''[[Kingella|kingella kingae]]'' may be encountered in immunocompromised hosts. Occasionally, noninfectious causes examples trauma from foreign objects inhalation and chemical burns have been found to cause [[epiglottitis]]. | |||
==Differentiating epiglottitis from other diseases== | ==Differentiating epiglottitis from other diseases== | ||
==Screening== | ==Screening== | ||
Revision as of 15:05, 18 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]
Overview
Epiglottitis is a soft tissue swelling of the epiglottis,[1] and the surrounding structures example; plica aryepiglottica , arytenoids, sinus piriformis and vestibular folds mostly caused by bacteria.[2] The epiglottis is a flap of tissue at the base of the tongue, which prevent food from going into the trachea. Due to its place in the airway, swelling of the epiglottis may interfere with breathing and constitutes a medical emergency. especially when it obstructs or completely close off the windpipe.
Historical perspective
One remarkable incidence of epiglottitis has been traced to George Washington; the first president of the United States on December 13, 1799. He was reported to have had sore throat and hoarseness of voice. At dawn the next day, his conditioned worsened with difficulty in breathing. Few hours later he was found to have respiratory distress and died few hours later of what was known to be due to acute epiglottitis.[3][4][5] In the 1980s Haemophilus influenza type b vaccine was introduced. Prior to this,[6] epiglottitis used to be mostly found in pediatric age group between 3 to 5 years. However, recent trend in North America favors adults as most commonly affected individuals.[7]
Classification
Epiglottitis may be classified according to the etiology, and disease duration into infectious and noninfectious causes. Infectious epiglottitis may be subclassified into bacterial, viral and fungal causes. Noninfectious epiglottitis is main due to trauma from foreign objects inhalation and chemical burns[8] On the basis of disease duration, epiglottitis is almost always acute in presentation requiring emergency treatment else the outcome is fatal.[9]
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.[10] 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. [11] IgA antibody accords the mucosa surface protection again attachment of the organism. The strategies deployed by a microbe to assist its survival and proliferation, may or may not lead to disease process. Epiglottitis caused by H. influenza may therefore be considered as an accidental consequence of the microbial factors that permit its survival.[12] 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.[13] 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.[14]
Causes
Prior to the introduction of Haemophilus influenza type b vaccine,[6] H. influenza was the most common culprit of epiglottitis. In recent literature, group A [beta]-hemolytic Streptococci is more commonly observed to be the cause. The disease used to be mostly found in pediatric age group of 3 to 5 years. However, recent trend favors adults as most commonly affected individuals.[7] Other pathogens such as escherichia coli, candida albicans, or kingella kingae may be encountered in immunocompromised hosts. Occasionally, noninfectious causes examples trauma from foreign objects inhalation and chemical burns have been found to cause epiglottitis.
Differentiating epiglottitis from other diseases
Screening
Risk factors
Natural history, complication and prognosis
Diagnosis
History and symptoms
Physical examination
Laboratory findings
Xray
ECG
CT scan
MRI
Ultrasound
Other imaging findings
Other diagnostic findings
Treatment
Medical therapy
Surgery
Prevention
References
- ↑ Shah RK, Stocks C (2010). "Epiglottitis in the United States: national trends, variances, prognosis, and management". Laryngoscope. 120 (6): 1256–62. doi:10.1002/lary.20921. PMID 20513048.
- ↑ Ossoff RH, Wolff AP, Ballenger JJ (1980). "Acute epiglottitis in adults: experience with fifteen cases". Laryngoscope. 90 (7 Pt 1): 1155–61. PMID 6967138.
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- ↑ 6.0 6.1 Schlossberg, David (2015). Clinical infectious disease (Second ed.). p. 202. ISBN 9781107038912.
- ↑ 7.0 7.1 Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
- ↑ Charles R, Fadden M, Brook J (2013). "Acute epiglottitis". BMJ. 347: f5235. doi:10.1136/bmj.f5235. PMID 24052580.
- ↑ Mathoera RB, Wever PC, van Dorsten FR, Balter SG, de Jager CP (2008). "Epiglottitis in the adult patient". Neth J Med. 66 (9): 373–7. PMID 18931398.
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