epiglottitis

Epiglottitis: description

An epiglottitis is an inflammation of the epiglottis caused by the bacterium Haemophilus influenzae type B. The epiglottis is located above the trachea and serves to close it during swallowing. Epiglottitis causes swelling of the mucous membranes and around the epiglottis. As a result, the air tube is constricted, which can lead to respiratory distress.

The condition is acutely life-threatening, as there is a danger of suffocation due to the swollen epiglottis. If epiglottitis is suspected, you should immediately alert an emergency physician. If the patient is about to suffocate, he must be artificially ventilated as soon as possible. Treated in good time usually heals the epiglottis without severe consequences.

Although epiglottitis often occurs in infants between the ages of two and six, it is generally possible for all age groups to get it. Especially since the nationwide vaccination an increase of cases in older children or adults is observed.

Epiglottitis: symptoms

Epiglottitis is always one emergency, Because respiratory distress can develop within less than six to twelve hours after onset of illness. Call an emergency doctor immediately, even if it turns out that the symptoms may have been caused by another condition. The following symptoms are probably due to epiglottitis:

• Those affected are very ill and complain of severe sore throat when speaking.
• The fever is over 39 degrees Celsius.
• The language is “kloßig”.
• Swallowing is usually no longer possible.
• Those affected can not swallow their own saliva because of the difficulty swallowing, which is why they frequently run out of their mouths.
• Some patients may or may not talk anymore.
• Breathing is difficult and sounds like snoring (aching breathing). This is partly due to the fact that a saliva lake has formed in the throat.
• The jaw is pushed forward and the mouth is open.
• The seated posture of the affected person is bent forward while the head is tilted backwards (coach seat), because breathing is easier.
• Patients are pale and / or blue.

Distinction epiglottitis and pseudo-group

An epiglottitis can be caused by a virus croup be confused. Both epiglottitis and the so-called pseudo-group (stenosing laryngotracheitis) are inflammations in the pharynx and therefore have similar symptoms, for example the swelling of the laryngeal cap. While the epiglottitis represents a life-threatening clinical picture, the pseudo-group is usually harmless. There are the following differences:

Epiglottitis: causes and risk factors

The epiglottitis is usually triggered by an infection with the bacterium Haemophilus influenzae type B. Rarely, other bacteria such as streptococci and staphylococci are responsible for the inflammation of the epiglottis. Since the introduction of the Haemophilus Influenzae type B vaccine (HiB vaccine), the disease occurs much less frequently.

In some cases, those affected by epiglottitis have a banal infection, such as a runny nose or a sore throat. Mostly, however, those affected get sick out of perfect health. In contrast to the much more common pseudo-group there is no seasonal accumulation in case of epiglottitis, a laryngitis can occur in every season.

Haemophilus influenzae type B

The bacterium Haemophilus influenzae type B, which causes epiglottitis, colonizes the mucous membrane of the respiratory tract (nose, pharynx, trachea) and can cause inflammation there. It is transmitted by coughing, talking or sneezing (droplet infection). The incubation period, ie the period between infection and the first symptoms, is between two and five days. Previously, the bacterium mistakenly believed it to be the cause of the flu (influenza) and called it “influenzae”.

Epiglottitis: examinations and diagnosis

For the experienced physician, the epiglottitis is a “gaze diagnosis”, that is, it detects the disease even by a simple inspection of the patient. The examinations are limited to the bare essentials, since anxiety and manipulation in the pharynx can aggravate the respiratory distress and trigger an asphyxia in children. A physical examination will be made by the doctor only if there are no breathing difficulties. There must always be equipment available for artificial respiration if it develops.

The doctor inspects the oral cavity and pharynx with a spatula. In children, the inflamed epiglottitis epiglottitis can already be seen by gently pushing away the tongue. If necessary, a laryngoscopy (laryngoscopy), or tracheal and bronchial reflection (bronchoscopy) is necessary. The epiglottis is noticeably red and swollen.

If the affected person struggles for air and turns blue (cyanosis), he should be ventilated early (intubated). For this purpose, a breathing tube (tube) over the mouth or nose is placed in throat to secure the airways. Thus, a self-breathing or breathing with a resuscitator can be made possible.

Epiglottitis: treatment

An epiglottitis will inpatient and intensive care provided. In the clinic, the patient is closely monitored and, if necessary, artificially ventilated. Infusions via a vein supply it with nutrients and regulate the fluid balance. He also receives intravenously administered antibiotics such as cefotaxime or cephalosporins over a period of ten days. Furthermore, cortisone (glucocorticoid) is administered via the vein to reduce the inflammation of the epiglottis. To relieve acute respiratory distress, a pump spray with epinephrine helps.

In case of imminent respiratory arrest, the affected person is intubated immediately, which may be difficult due to the epiglottitis. In addition, an adrenaline spray is administered. Sedatives such as benzodiazepines should not be given, as these medications may worsen respiratory distress. In rare and severe cases, when intubation through the swelling is not possible, a tracheostomy (tracheotomy) is performed.

As a rule, the patient is artificially ventilated for about two days. He will not be released until more than 24 hours have passed.

Epiglottitis: measures until the ambulance arrives

In the case of epiglottitis, until the ambulance arrives, you should calm the patient, as unnecessary excitement can aggravate the respiratory distress. Never try to look down the neck and open the windows for fresh air. Pay attention to which attitude the affected person wants to take.

Epiglottitis: prevention

Since epiglottitis is often caused by the bacterium Haemophilus influenzae, the HiB vaccine (Haemophilus influenzae type B) is an effective protection against. The vaccine is from the Standing Vaccination Commission of the Robert Koch Institute (STIKO) for infants from the second month of life recommended. Further vaccinations take place in the third, fourth and twelfth month of life. Booster doses are not necessary after complete primary immunization. Primary immunization is important in order to develop sufficient vaccine protection to effectively prevent epiglottitis.

Epiglottitis: disease course and prognosis

With timely therapy, the symptoms improve within a few days and the epiglottitis heals without consequential damage. If the epiglottitis is recognized too late, or treated, it can find a fatal outcome.

Suffocation is the most dreaded complication of Epiglottitis. That’s why it ends today in 10 to 20 percent of cases deadly.