Epiglottitis

introduction

Epiglottitis (Epiglottitis) is an acutely occurring, mostly bacterial life-threatening disease. Haemophilus influenza type B in particular can colonize the epiglottis. In rare cases, other pathogens are also possible.

The massive swelling of the epiglottis can impede breathing and require intensive medical care. Epiglottitis (epiglottis) must be treated as an emergency.

Symptoms

Epiglottitis (Epiglottitis) occurs acutely. It is accompanied by pain when swallowing, a whistling noise when inhaling (inspiratory stridor) through the narrowing of the airways, increased saliva production and usually with a high fever. The shortness of breath is followed by a poor oxygen supply, which can be indicated by a blue discoloration (cyanosis) of the face. The doctor may notice reddening of the epiglottis and swelling of the epiglottis during the examination. Difficulty breathing can cause fear of death. Patients especially children behave in a panic and gasp - It is very important to calm down the sick (Epiglottitis) as the excitement makes the shortness of breath worse. To make breathing easier for the patient, a sitting position is recommended.

fever

Epiglottitis typically begins suddenly and with pronounced symptoms. Fever is a classic symptom, along with sore throat and swallowing pain, as well as dry breathing sounds when inhaling. The fever comes on suddenly and can rise to high temperatures.

Lumpy language

The lumpy language, which is one of the typical symptoms of epiglottitis, is triggered by the swelling in the throat. Due to the swollen mucous membrane in the area of ​​the vocal cords, the airflow changes when speaking, which is then perceived as lumpy.
Furthermore, similar to swallowing, irritation of the inflamed mucous membrane occurs. Due to the higher sensitivity of the pain fibers, speaking, just like swallowing, can be painful.

Pain when swallowing

A sore throat and the associated difficulty swallowing are caused by the acute inflammation and swelling in the area of ​​the throat. Inflammation of the mucous membrane in this area also causes the pain fibers of the mucous membrane to become more sensitive to stimuli. This makes the act of swallowing very painful.
In addition to pain when swallowing, increased saliva production is typical of epiglottitis. Since swallowing is painful, the child's saliva often runs out of the mouth because it cannot be swallowed or the child cannot swallow due to the pain.

course

The onset of epiglottitis can, regardless of age, occur very suddenly and one rapid course to take.
In the beginning there is above all that rapidly rising fever with up to 40 ° C, severe difficulty swallowing and a profuse salivation at the center of the symptoms.

Patients suffer from swelling of the epiglottis severe breathing difficultieswhich can be recognized by typical inhalation and exhalation noises.

In addition, the inflammation can now also be seen from the outside. The larynx is plump and red and can have small white spots, so-called Abscesses, exhibit. These abscesses are a collection of pus and an expression of severe inflammation. Often times, patients lean forward with their torso and rest their elbows on their thighs to help them breathe.

If the epiglottitis is not treated, it can become severe acute shortness of breath and Lack of oxygen come. This situation now presents one absolute emergency If it is not treated adequately, it can in extreme cases to death come.

Epiglottitis thus presents itself as a very rapidly occurring disease that can lead to a massive deterioration in the patient's condition within a few hours and therefore in medicine viewed as an emergency becomes.

Risk of contagion

During acute epiglottitis there is a high risk of infecting other people, as it is a droplet infection.

Strict hand hygiene must therefore be observed, especially with small children. Since this is a serious illness, it was agreed that all family members of the patient should take an antibiotic as a prophylaxis to prevent infection.

In the case of children attending kindergarten, it is highly advisable to notify them so that preventive measures can also be taken for the other children.

therapy

Epiglottitis (inflammation of the epiglottis) should be treated immediately by a doctor. It can suddenly develop into an intensive care emergency.
There is a risk of the airways being completely obstructed and thus a risk of suffocation. Therefore, those affected should be transported to hospital immediately. It is often necessary that the patient has a tube inserted into the windpipe (intubation) or the airways through an incision in the windpipe (Tracheotomy) are backed up.

The bacterial colonization of the epiglottis is combated by intravenous antibiotic therapy.

When do you need intubation?

Epiglottitis should always be treated as an inpatient, i.e. in the hospital. The most important therapeutic measure is the administration of oxygen. If this is not sufficient, intubation must be considered. This is so important because the airways can suddenly swell so much that breathing becomes impossible.
This means that intubation should be considered early on, before it is too late in the end. Factors in favor of intubation include shortness of breath with an increased breathing rate, a dry sound when breathing in, an increased heart rate or a very abrupt onset of symptoms.
The decision to intubate is made based on the patient's overall clinical picture.

forecast

Will epiglottitis (Epiglottitis) left untreated, the prognosis is very poor. The patient suffocates because the airways are blocked. With the help of antibiotic therapy and intensive medical care, however, the chance of a cure without consequences is very good. Up-to-date medical care is important. With this disease (epiglottitis) you shouldn't lose any time.

prophylaxis

There are different types of the bacteria - the most common is type B, which can be vaccinated against. The vaccination contains harmless capsule components of the bacterium against which the immune system forms antibodies. Incidentally, the Haemophilus influenzae (HiB) vaccination is primarily used to protect against meningitis (meningitis) which is only triggered by the encapsulated type B. This vaccination is recommended for all children from the age of three months (Epiglottitis).

Epiglottitis despite Haemophilus influenzae type B vaccination

Thanks to the introduction of the Hib vaccination, the incidence of epiglottids has decreased significantly.
The few cases that will be described are mainly due to patients who have either not been vaccinated or who suffer from a weakened immune system.

There are other pathogens that can cause symptoms similar to those of Hib. These include, in particular, streptococci, staphylococci, pneumococci, varicella zoster, Klebsiella pneumoniae and Neisseria menigitidis. However, some forms of fungi, such as Candida albicans, which is found on many surfaces of the body, can also cause epiglottitis.

causes

The epiglottis is a cartilaginous structure on the base of the tongue that can seal off the windpipe. This is very important during the swallowing process: it must be prevented that liquids or food components enter the windpipe and via this route into the lungs. Otherwise this can lead to pneumonia (so-called aspiration pneumonia) to lead. Inflammation of the epiglottis (epiglottitis) is primarily caused by the bacterium Haemophilus influenzae. The mucous membrane of the epiglottis swells, which hinders breathing and can lead to suffocation (epiglottitis).

Read more about this under Laryngitis in the child

frequency

Epiglottitis (inflammation of the epiglottis) occurs mainly in young children. Since vaccination for Haemophilus influenzae type B, the incidence of the disease has decreased significantly.

Typical age of onset

The typical age of onset an epiglottitis lies between the second and sixth year of life.
Since they are im classic kindergarten age it is one of the dreaded kindergarten diseases.
But also teenagers and Adults can be affected, albeit clearly less common.

Adult epiglottitis

Epiglottitis is most common in young children between the ages of two and six.
Nevertheless, epiglottitis occasionally occurs in adults.
Pneumococci and streptococci in particular come into consideration here as pathogens.

Mainly affected at this age are immunocompromised patients in whom the immune system can no longer adequately contain these pathogens. Epiglottids can also be caused by Haemophilus influaenza type b in adults if the vaccination did not take place in childhood.

With regard to the course, there are also differences in adults compared to children. The symptoms show a similar rapid course at the beginning, but they differ significantly in their severity. This is due to the fact that the airways of adults are much larger in diameter than those of small children and therefore sufficient air can pass through the airways for a relatively long time if the epiglottis is inflamed.
The rate of severe complications and courses as a result of epiglottitis is significantly lower in adults than it is in small children.

Differences to the pseudo croup

Sometimes it can turn out to be quite right at first difficult represent a Differentiate epiglottitis from pseudocroup, since both diseases mainly affect small children between the ages of two and six.

On the other hand, if you look closely at the individual diseases, large differences in severity and course can be determined.
The term Pseudo group refers to an acute inflammation of the upper airways under the vocal cords. So one already exists here big difference in localization of the two diseases.

Will continue Pseudo croup, in contrast to epiglottitis, usually by viruses causes and arises in the course clearly weaker The fever is often less pronounced here and the characteristic severe pain when swallowing are absent. Often, however, a dry, strong cough can be recognized, which is also known as Croup referred to as. In addition runs the disease as a whole slowerthan is the case with epiglottitis. Severe cases that are accompanied by acute shortness of breath occur only very rarely.

A another difference represents the following therapy Since this is a virally caused inflammation, would Antibiotics in this case have no effect demonstrate. The body will get the disease under control on its own and may be able to help anti-inflammatory drugs get supported. In contrast, will with epiglottitis a high-dose antibiotic given.

Read more about the topic here: Pseudo croup