upper airway Flashcards
what is Epiglottis? common organisms in adults and kids? treatment?
The patient has acute, adult-onset epiglottitis with airway obstruction. Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx with inflammation of the epiglottis, vallecula, arytenoids, and aryepiglottic folds. In the United States, epiglottitis is an uncommon disease with an incidence in adults of about 1 case per 100,000 per year. Adult epiglottitis is most frequently a disease of men occurring during the fifth decade of life. Symptoms occur abruptly. Historically, acute epiglottitis was most common in children aged 2-4 years. In a 2005 retrospective review of patients with acute epiglottitis, symptoms of stridor, voice muffling, rapid clinical course, and a history of diabetes mellitus were significantly associated with the need for airway intervention. On an X-ray, epiglottitis is identified by “thumb sign.” This is noted when the epiglottis juts out into the airway like the end of a thumb. You can see the edge of the epiglottis outlined in the image below using a yellow line. A normal epiglottis should be a very thin sheet of connective tissue rather than a large, bulbous knob as shown.
Ideally, patients with epiglottitis would have a culture performed to guide antibiotic management. Empiric therapy should be targeted towards Haemophilus influenzae type b, Streptococcus pneumoniae, including strains that may be penicillin-resistant, Group A Streptococcus, and Staphylococcus aureus, including MRSA. This would generally require vancomycin in addition to a third-generation cephalosporin such as ceftriaxone.
In adults, the most common organisms that cause acute epiglottitis are Streptococcus pneumoniae, Haemophilus influenzae, H. parainfluenzae, and group A streptococci. Less common infectious etiologies include other bacteria (Staphylococcus aureus, mycobacteria, Bacteroides melaninogenicus, Enterobacter cloacae, Escherichia coli, Fusobacterium necrophorum, Klebsiella pneumoniae, Neisseria meningitidis, Pasteurella multocida), herpes simplex virus (HSV), infectious mononucleosis, Candida (in immunocompromised patients), and Aspergillus (in immunocompromised patients).
The most common organism in adults is Streptococcus pneumoniae. In children, H. influenzae (strains not found in the immunization) is still the most common organism. The treatment for epiglottitis is with a third-generation cephalosporin and with the addition of vancomycin in areas with a high prevalence of MRSA.
