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Epiglottitis

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Epiglottitis Causes

Causes of epiglottitis include infectious, chemical, and traumatic agents. Infectious is the most common. H influenzae type b was once the most common cause prior to vaccination. Currently, other organisms such as bacteria, viruses, and fungi are the causes, especially among adults.

  • Various organisms that can cause epiglottitis include Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1, and Staphylococcus aureus, and others.
  • Other types of epiglottitis that are not caused by infection include hot things that may injure the epiglottis. Heat damage that results in epiglottitis is also known as thermal epiglottitis. Thermal epiglottitis occurs from drinking hot liquids; eating very hot solid foods; or using illicit drugs,for instance inhaling the tips of marijuana cigarettes metal pieces from crack cocaine pipes. In these cases the epiglottitis from thermal injury is similar to the illness caused by infection.
  • Unusual causes of epiglottitis include brown recluse spider bites to the ear, which may result in swelling, or eating buffalo fish, which may cause an allergic-like reaction and swelling. Blunt trauma or something blocking the throat may also lead to epiglottitis.

Epiglottitis Symptoms

When epiglottitis strikes, it usually occurs quickly but may range from just a few hours to a few days. The most common symptoms include sore throat, muffling or changes in the voice, difficulty speaking, fever, difficulty swallowing, fast heart rate, and difficulties in breathing.

Fever is usually high but may be low at 100.1° F in adults or even slightly lower at 99° F in cases of thermal epiglottitis.

  • Signs of respiratory distress, or trouble breathing, are seen with epiglottitis. Signs include drooling, leaning forward to breathe, taking rapid shallow breaths, "pulling in" of muscles in the neck or between the ribs with breathing, a high-pitched whistling sound when breathing, and trouble speaking. Someone with acute epiglottitis usually looks very ill.
  • Children may sit in a "sniffing position" with the body leaning forward and the head and nose tilted forward and upward.
  • People with epiglottitis may appear restless and breathing with their neck, chest wall, and upper belly muscles. While they may be taking in less air with each breath, they will still manifest the high-pitched whistling sound, called inspiratory stridor.
  • Typically, a child who comes to the hospital with epiglottitis has a history of fever, difficulty talking, irritability, and problems swallowing for several hours. The child often sits forward and drools. In infants younger than 1 year of age, signs and symptoms such as fever, drooling, and upright posturing may all be absent. The infant may have a cough and a history of an upper respiratory infection. Thus it is very difficult to know if an infant has epiglottitis.
  • In contrast, adolescents and adults have more recognizable symptoms with sore throat being the main complaint along with fever, difficulty breathing, drooling, and stridor (noise with breathing). 
  • Doctors have characterized adult epiglottitis into 3 categories:
    • Category 1: Severe respiratory distress with imminent or actual respiratory arrest. People typically report a brief history with a rapid illness that quickly becomes dangerous. Blood cultures, which are tests that check for bacteria in the blood, are often positive for Hib.
    • Category 2: Moderate-to-severe clinical symptoms and signs of considerable risk for potential airway blockage. Symptoms and signs usually include sore throat, inability to swallow, difficulty in lying flat, muffled "hot potato" voice (speaking as if they have a mouthful of hot potato), stridor, and the use of accessory respiratory muscles with breathing.
    • Category 3: Mild-to-moderate illness without signs of potential airway blockage. These people often have a history of illness that has been occurring for days with complaints of sore throat and pain upon swallowing.

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