Epiglottitis: cause, diagnosis, a symptom of Covid?

Epiglottitis is a form of laryngitisThis is’inflammation of the epiglottis and surrounding tissues, most often of infectious origin. Among the most common symptoms: an intense sore throat and noisy and difficult breathing (called stridor). The first President of the United States george washington died of it in 1799. What is epiglottitis? What are the symptoms ? In the child? In adults? How is the diagnosis made? With what treatments to treat it? Is there a vaccine to limit the risks? Lighting.

Definition: what is epiglottitis?

Acute epiglottitis is inflammationmost often of infectious origin, of the epiglottisa structure located after the pharynx, triangle-shaped, which protrudes into the glottis. It’s a kind of small clapperboardt which bars the entrance to the larynx and trachea at the time of swallowing (see diagram below).

What are the symptoms of epiglottitis?

Epiglottitis does not cause very suggestive symptoms, which complicates the evocation of the diagnosis. In addition, the symptoms are very different in children and adults.

Symptoms in children:

• Quick installation ofa stridor, in other words, an abnormal noise (more or less strident) emitted by breathing
• A dysphagiaa swallowing disorder manifested by difficulty swallowing food and drink
• Signs of respiratory distress with severe chest pain
• The child tends to position himself seated, leaning forward
• A high fever
• Hypersalivation
• A voice change
• A significant deterioration in general condition

Symptoms in adults (symptoms usually take longer than 24 hours to develop) :

• Inflammatory signs are extended to surrounding structures of the epiglottis, sometimes the oropharynx
• Pharyngeal discomfort, associated with odynophagia and to dysphagia (swallowing disorders characterized by difficulty swallowing and pain when swallowing)
• In half of the cases, a change in the voice (muffled voice), stridor and difficulty in breathing
• Fever and general signs are more rarely encountered.

Can epiglottitis be a new symptom of Covid (Omicron)?

The Omicron variant could cause symptoms suggestive of epiglottitis, but closer to acute odynophagia, a swallowing disorder.

A swedish studypublished on February 15, 2022 on the PubMed platform highlighted symptoms resembling epiglottitis in patients who have been infected with Covid-19 (Omicron variant). “We describe a new group of COVID-19 patients (of cases of Covid-19, referred to the ENT emergency department between January 1 and January 23, 2022) seeking emergency care with symptoms similar to life-threatening epiglottitisdescribe the researchers. The Omicron variant appears to primarily affect the upper respiratory tract and cause acute laryngitis without olfactory dysfunction. In some patients, the clinical manifestation is similar to symptoms of epiglottitis. In such a case, a prompt examination of the larynx is the gold standard for ruling out inflammatory upper airway edema. None of the patients described here developed epiglottitis“. In other words, the Omicron variant could cause symptoms suggestive of epiglottitis, but closer to acute odynophagia, a swallowing disorder.

Is epiglottitis more common in children or adults?

Epiglottitis was primarily considered a a disease of children from 1 to 7 years old. “For a long time, acute epiglottitis remained a specific pathology of young children. The introduction and generalization of the anti-Haemophilus influenzae type b (Hib) vaccination has led to a drastic reduction in pediatric forms“, can we read in a french study published in 2015 by the French-language Resuscitation Society (SRLF). In adults, the cases of epiglottitis are on the increase, with a clinical form and course that is significantly different from that of children, a male predominanceand a mean age of onset comprised between 40 and 50 years old. The presence of associated comorbidities is frequently found: between 8 to 82% of cases. The most common comorbidities are an diabetes, high blood pressure or immunosuppression. There is also a high prevalence of smoking among people with epiglottitis.

Transmission: what is the cause of epiglottitis?

Epiglottitis is an inflammation of the epiglottis, most often of infectious origin.

• Shapes bacterial (beta-hemolytic streptococci, pneumococci, Gram-negative bacilli (Klebsiella, Pseudomonas, Acinetobacter)) are largely in the majority
• Shapes viral exist, especially with viruses of the herpes group
• Shapes fungal (mushrooms) are more rare, especially with Candida, Aspergillus, Histoplasma, observable in immunocompromised patients.
• Shapes non-infectiousof thermal origin (most often by inhalation) exist

Epiglottitis is based on patient history and clinical examination (throat examination) based on symptomatology and narrowing of the larynx. Diagnosis can be confirmed by analysis of the epiglottis and adjacent supraglottic structures, via fibroscopy (laryngoscopy) flexible. It allows direct visualization of the epiglottis which represent edema and inflammation, thus eliminating the other clinical differential diagnoses (angioedema, isolated pharyngeal abscess, uvulitis, etc.). A scanner to confirm the diagnosis is performed when flexible laryngoscopy is not possible. The interest of the scanner lies above all in the search for complications (abscess (rare)…).

In the most severe forms and in children, epiglottitis represents a medical emergency. “The therapeutic challenge is to maintain the freedom of the upper airways (VAS), if necessary after intubation or tracheotomy“, recalls the SRLF. In other words, ensure that the upper airway remains open. A antibiotic therapy intravenous injection is (almost) systematic in all patients. Furthermore, the use of corticosteroids or nonsteroidal anti-inflammatory drugs can be considered

The evolution under treatment of acute epiglottitis is most often favorable in a few days

What is the risk of mortality in the event of epiglottitis?

The evolution under treatment of acute epiglottitis is most often favorable in a few days, even when an intervention on the upper airways was necessary, if it could be carried out in good conditions “Mortality is weak. However, a fatal development by hypoxic cardiac arrest is possible, and unpredictable, in case of upper airway obstruction”says the French-language Resuscitation Society.

Is there a vaccine to prevent epiglottitis?

Epiglottitis can be prevented by vaccination against Haemophilus influenzae type B (Hib). This vaccine is, since January 1, 2018, compulsory for all infants from the age of 2 months, since January 1, 2018

Sources: Severe acute epiglottitis in adults, French-language resuscitation society, December 10, 2015