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Epiglottitis

Epiglottitis: Pathogenesis and clinical findings Infectious cause: Bacterial (Staphylococcus aureus, Streptococcus pneumoniae, Neisseria meningitidis, or most commonly Haemophilus influenzae in unimmunized children), viral or fungal Authors: Alisha Ebrahim Reviewers: Simran Sandhu Mao Ding Michelle J. Chen Danielle Nelson* * MD at time of publication Infectious agent invades the bloodstream and/or the epithelial layer of the epiglottis, aryepiglottic folds and adjacent structures, allowing for spread Non-infectious cause: Ingestion of toxin or foreign body, thermal injury, or trauma The potential space between the squamous epithelial layer and the epiglottal cartilage fills with inflammatory cells such as neutrophils and eosinophils Exudate of inflammatory cells spreads through the lymphatic and blood vessels in the lingual surface of the epiglottis and periepiglottic tissues Fluid and inflammatory cells accumulate between the squamous epithelial layer and epiglottal cartilage Swelling of the entire supraglottic larynx Tripod/sniffing position (Anxious- looking and sitting with trunk leaning forward, neck hyper-extended and chin pushed forward to maximize airway diameter) Stridor (High-pitched sound that is produced by obstruction in the larynx or just below) Stertor (Low-pitched noise created in the nose or the back of the throat) Retraction of the intercostal and suprasternal muscles Tachypnea (Rapid breathing) Increased weight and mass of the epiglottis Epiglottis curls posteriorly and inferiorly Ball-valve effect (Airflow obstructed during inspiration as epiglottis is pulled over airway but not during expiration as epiglottis moves back into position) ↓ Diameter of upper airway Epiglottis obstructs the esophagus Dysphagia (Difficulty swallowing) Cyanosis (Blue tint to skin) Turbulent inspiratory airflow Aspiration of oropharyngeal secretions Hypoxemia (Low oxygen levels in blood) ↓ Air entry to lungs Airway obstruction ↑ Work of breathing Drooling Pain when swallowing Muffled/”hot potato” voice Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Feb 5, 2024 on www.thecalgaryguide.com