Adult epiglottitis: an under-recognized, life-threatening condition

Abstract

Epiglottitis in the adult can be fatal and should be treated with the same degree of concern and suspicion in respect of airway patency as in children. We present three cases of adult epiglottitis in which the airway was lost prior to or during the intervention of an anaesthetist. We suggest that an emphasis on conservative management is distracting and belies the serious nature of this disease.

Supraglottitis in the era following widespread immunization against Haemophilus influenzae type B: Evolving principles in diagnosis and management

“…2,7,13 The incidence of adult supraglottitis has stayed relatively constant at 1 to 4 per 100,000 people per year. 4,7,13 These numbers have been quoted to be even higher in some countries outside of the United States. 1 As the demographics of supraglottitis have changed, so has the typical presentation.…”

“…[1][2][3] Case reports from other hospitals have also identified new challenges in recognizing adult supraglottitis during the postvaccine era. 4,5 The frequency of supraglottitis in adults is now greater than that in children, 6,7 and clinicians recognize that the presenting symptoms of supraglottitis are no longer the classic presenting symptoms taught in medical school.…”

“…1,2,4,6,9 Management decisions are also complicated by current trends in the bacteriology of supraglottitis. Hib is still a cause of supraglottitis in the postvaccine era owing to vaccine failure and incomplete herd protection.…”

“…Personal accounts of clinicians also demonstrate that a changing presentation and demographic of supraglottitis have been directly responsible for suboptimal management of the disease and patient mortality. 4 To accurately diagnose and effectively treat individuals affected by supraglottitis, it is necessary to define new trends in presentation, interventions, outcomes, and demographics of the disease in the years following widespread vaccination against Hib. By reviewing both adult and pediatric data from two tertiary referral centers, we aim to better delineate the modern course of supraglottitis and suggest new paradigms of treatment in an era when the traditional epiglottitis protocol may no longer be valid.…”

Pseudomembranous supraglottitis with airway compromise in a patient with recurrent tonsillar carcinoma

“…21,22 Most commonly, blood cultures remain negative in patients with adult epiglottitis, 5,8,12 and cultures obtained directly from the epiglottitis and surrounding tissue during laryngoscopy also fail to identify the responsible bacterial pathogen. 7 As a result of these data, blood, epiglottic, and oropharyngeal cultures were not obtained in our patient and instead, empiric treatment with a broad-spectrum intravenous antibiotic (piperacillin-tazobactam) was instituted in order to provide coverage against H. influenzae, Streptococcus species, and Corynebacterium diphtheriae.…”