Epiglottitis: in children, adults, symptoms,treatment

Update: December 2018

Content:

  • The reasons
  • Pathological changes in the body
    • Clinic
    • Features in children
    • Features in adults
    • Clinical types
    • Complications
  • Diagnostics
  • Therapy
  • Prevention


Epiglotititis is an inflammation of the epiglottis and nearby
tissue, leading to disruption of normal patency
airways. To make the mechanism more understandable
the occurrence of the disease and the causes of these or other symptoms
(signs) of epiglotitis, consider the structure of the larynx.

Larynx – skeleton, consisting of cartilage, muscular, mucous
tissue forming the entrance to the trachea. Epiglottis – movable cartilage
larynx, resembling a flower petal, performing
the function of the valve mechanism between the trachea and the pharynx. He is not
allows ingestion of food bolus in the trachea. With the act of swallowing
epiglottis obscures the lumen of the trachea, and food is free
moves into the esophagus. Due to this we do not know how.
simultaneously speak and swallow. If we do not eat, epiglottis
rises slightly and the entrance to the trachea becomes open.

When the epiglottis is inflamed, it swells, narrowing or completely
blocking the passage to the trachea. This is how respiratory blockage forms.
pathways with epiglottitis.

Acute epiglotitis is more common in 2–5 year old children, but may
older children and even adults will suffer.

The reasons

When colds are most often the causative agent of epiglotitis is
hemophilus bacillus type B, which still causes pneumonia
(pneumonia) and pia mater (meningitis). Transmission Path –
airborne Possible asymptomatic pathogen carrier state
sticks in the nasopharynx. In adverse conditions, it is activated
and causes the development of the disease.

Other microbes can cause epiglotititis:

  • pneumococcus, causative agent of pneumonia and mild cerebral
    shell (meningitis);
  • streptococci a, b, c, which are the cause of pustular
    diseases, sore throats, rheumatism;
  • yeast fungus candida resulting in
    thrush;
  • varicella zoster virus, chickenpox pathogen (varicella
    smallpox).

In addition to the common cold, epiglotitis can develop after:

  • injuries with damage to the epiglottis (including mechanical
    damage, for example, fish bone),
  • burns (by eating too hot food, drinking, while
    exposure to chemicals, most often acids and alkalis),
  • smoking cocaine or other drugs.

In the early and mid-20th century, epiglotitt was sufficiently
common, especially among children 2-7 years. After ubiquitous
immunization of the child population from hemophilus bacilli during
vaccination company, which started in 1985, the number
epiglottitis cases decreased significantly.

Risk factors for epiglotitis

  1. Floor. In men, the disease is more common than in women.
  2. Race. Black people are more susceptible to infection.
  3. Social status. Less availability of medical care, in
    including vaccination among the population below the poverty line,
    leads to greater prevalence of epiglottis.
  4. Belonging to an organized team. More often sick children
    attending kindergartens, schools, various sections. Among adults
    the risk of getting sick is higher in office workers, factory workers,
    factories than ipl.
  5. The level of immune protection. With the weakening of the immune system increases
    susceptibility to disease.

Pathological changes in the body

Under the influence of viruses, swelling occurs, capillary rupture,
hemorrhage in the epithelium. Disruption of the epithelial layer
promotes the penetration of bacteria, the further development of edema and
inflammation.

Clinic

Epiglottitis in children and adults is usually preceded by infection.
upper respiratory tract. With the rapid progression of clinical
manifestations already within 2-5 hours may occur complete
airway blockage due to edema and inflammation
epiglottis.

Symptoms of epiglotitis

  • temperature rise;
  • noisy wheezing;
  • redness, sore throat;
  • agitation, irritability;
  • salivation;
  • muffled voice, determined during a conversation;
  • blue nasolabial triangle, lips (this sign indicates
    lack of oxygen in the body);
  • heart rate increase (compensatory mechanism,
    included due to lack of oxygen in the blood);
  • difficulty swallowing.

To facilitate the state, the child intuitively takes
forced position, which somehow allows him to breathe:
sits, bending forward, stretching his neck, opening his mouth and sticking his tongue out.
When trying to make a breath, the participation of auxiliary
musculature (swelling of the nose wings, intercostal ribs,
supraclavicular fossa).

Features in children

The disease is caused by type B Haemophilus wand, in the case of
immunodeficiency is possible epiglottitis caused by fungi of the genus
Candida.

The younger the child, the more rapidly the symptoms develop.
diseases. At the age of 2-5 years the clinic grows over
a few hours. At an older age, the main manifestations
Diseases appear in 1-2 days.

Epiglottitis in children is usually preceded by ARVI, flu. On this
the background of the clinic is rapidly increasing, within 4-6 hours it can
an airway blockage occurs.

Children have 3 main features: difficulty breathing,
salivation, dysphagia (difficulty swallowing). Sore throat
like pain in tonsillitis, children gag, complain
pain in the ears, neck, dry throat. Voice is broken as
constriction of the larynx, increased heartbeat, shortness of breath, cyanosis
skin integument.

In acute epiglottitis in children with an abscess form,
possible empyema of the pleura, mediastinitis, formation
abscess High probability of death due to violation
airway.

Features in adults

The older the age, the more likely pathogens
epiglottitis. In addition to the hemophilus bacillus, these may be B –
гемолитический стрептококк групп А, В, С, пневмококк,  вирусы
influenza and herpes simplex, Klebsiella, pseudomones.

Onset is less acute than in children. Clinic
develops more slowly. Complications of impaired patency
airways is rare since in adults
much wider diameter. The main signs of epiglottitis in
adults: sore throat, cyanosis of the lips, drooling, shortness of breath.

Clinical types

Edematous form manifests itself:

  • manifested by pain when swallowing
  • signs of intoxication – blood products of decay and
    microbial metabolism (lethargy, drowsiness),
  • pain determined by palpation (one of the methods
    examination – determination of pathological abnormalities by
    feelings) neck
  • рост температуры до 37-390С,
  • яркое покраснение слизистой оболочки epiglottis.

Pathology of the lower parts of the larynx is not marked. In the jab
there is an increase in ESR (erythrocyte sedimentation rate),
increase in the number of leukocytes (leukocytosis). These signs
неспецифичны, указывают на наличие inflammation.

Infiltrative and abscess form

With infiltrative and abscess variants of acute
epiglottitis patient’s general condition is severe.

  • Температура при этом повышается до 38-390C,
  • worried about the unbearable sore throat,
  • feeling of lack of air, difficulty breathing.
  • The tongue has a dirty gray patina, an epiglottis swollen,
    red, edema extends to the pear-shaped sinuses and folds
    between the cartilaginous cartilage and epiglottis.
  • With an abscess form through the edematous mucosa
    shine through the pus.

Complications

With delayed treatment, complications may appear in the form of:

  • total airway obstruction (if in this case it is not
    take emergency measures then death is possible);
  • The overlap of the airways inflamed epiglottis;
  • pneumonia (pneumonia);
  • cervical lymphadenitis (lymphadenopathy on
    neck);
  • pericarditis (inflammation of the lining of the heart);
  • pleurisy (accumulation of fluid in the pleural cavity).

Diagnostics

The diagnosis of epiglottitis can be suspected already during the inspection, with
in the form of a child who has assumed a compulsory position peculiar to
этого diseases. When inspecting the throat you need to be extremely
careful as this study may lead to blocking
respiratory tract. In no case can not push on the root of the tongue
spatula, stimulating the reflex closure of the laryngeal lumen
(laryngism).

Further diagnostics may be required.
проведение рентгена  горла для выяснения уровня
spreading edema. X-ray in lateral projection
determined by an enlarged epiglottis (a symptom of a large
finger). It must be remembered that the absence of this feature is not
removes the diagnosis of epiglottitis, and the conduct of this study 
может отсрочить проведение мероприятий,  восстанавливающих
проводимость respiratory tract.

Inspection of the epiglottis performed using a special device –
fibrolaryngoscope. A child is transported to the operating room and
sitting position to inspect. Given the possibility of development
laryngism, everything must be prepared for surgery
to restore the airway:

  • tracheostomy (creating a message – a stoma between the trachea and
    external (ambient) environment, performed by opening the trachea and
    hemming the incision edge of the trachea to the skin);
  • tracheotomy (opening of the trachea with the introduction into the incision tube);
  • tracheal intubation (introduction to the trachea tube).

Stages of intubation

In adult patients with suspected epiglottitis also conduct
боковую рентгенографию и осмотр с помощью fibrolaryngoscope.
Performed in the operating room with the willingness to intervene,
restoring respiratory permeability.

When about. epiglottitis from the pharynx in patients sowed hemophilic
палочку и другие возбудители diseases.

Differential diagnostics is performed with all diseases,
вызывающими нарушение airway. During
an attack of bronchial asthma, the patient also takes a forced
sitting position, slightly leaning forward. Breathing is noisy
wheezing Unlike epiglottitis, it is not the inhalation that is difficult, but the exhalation.

Dyspnea with rhinitis is caused by filling the mucus of the nasal passages.
Breathing through the mouth is free. With the release of the nasal passages from
mucus recovers nasal breathing.

Treatment

Key clinical guidelines for suspected epiglottitis
are reduced to the speedy hospitalization of the patient. Transportation to
his car is dangerous because at this time the patient may
a deadly complication occurs – a state of complete
нарушения airway. Better not to risk, but
call an ambulance and go along with the patient as
accompanying person

When should parents sound the alarm? Should alert
a dramatic change in the child’s behavior: he may wake up among
Nights or will make painful grimaces during the day, complain about
severe sore throat. Clinic заболевания развивается стремительно.
With epiglottia, the child tries not to lie, but to sit, a little
leaning forward, stretching his head. He is like a fish thrown on
land, will gasp for air. The tongue will be stuck out, marked
difficulty breathing, shortness of breath, drooling may occur.
Температура поднимается до 37-400.

In this situation, the main thing is not to get lost, but to calm down and
try to comfort the child. Do not try to own
make out a sore throat by pressing on the tongue or trying 
change the position of the child to the more familiar to you. All these
attempts will only aggravate the patient’s condition and may lead to
complete airway blockage with an inflamed epiglottis.

As far as possible, you should encourage the child: “Be patient,
it will be easier for you soon. Doctors will help you. Breathe slowly, evenly. ”
Your peace of mind will be passed on to the child and it will be easier for him to survive.
unusual situation for him. When transporting, to facilitate
condition of the patient, open the window and seat the child so that
he was easier to breathe. Tight clothing should not hamper breathing.
ways: unbutton shirt collar.

Do not wrap it in warm clothes at this time, include
stove in the car. This can lead to dry mucous membranes.
respiratory tract. The main thing in this situation is not to interfere with the child. is he
he himself intuitively selects the most comfortable position for breathing.

Treatment эпиглоттита проводят в отделении реанимации и
intensive care. Recovery is performed here.
airway patency in one of the following ways:
(tracheotomy, tracheostomy, tracheal intubation). Further help
consists in the complex therapy including the following main
Components:

  1. Antibiotic therapy to kill the germs that caused
    diseases. Conducted taking into account the sensitivity test.
    Hemophilic bacillus is most susceptible to antibiotics from the group
    cephalosporins (cefazolin, cefalexin, ceftriaxone, cefepime) and
    aminopenicillins (amoxicillin, amosin, flemoxin, ospamox,
    ampicillin). Preferred intravenous route of administration. Course 7-10
    days
  2. Glucocorticoids (dexamethasone, hydrocortisone) to reduce
    swelling, removing other signs of inflammation of the epiglottis in the form of
    inhalation and intravenous administration.
  3. Intravenous administration of immunoglobulins, nutrients,
    fluid for the patient, sedatives.
  4. Setting on the neck of compresses with dimexidum.
  5. To prevent drying of respiratory mucous membranes
    Ways to use a humidifier in the room of the patient.
  6. When infiltrative form on the epiglottis mucosa
    notches are performed in areas of greatest edema. If any
    abscess of the epiglottis is performed by his autopsy, which improves
    breathing and reduce tissue tension.

Prevention

To prevent epiglotitis, children are vaccinated against
гемофильной палочки – наиболее частого возбудителя diseases. With
the illness of one of the family members, the rest is carried out
профилактическое treatment антибиотиками.

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