LA CONSULTA SEMANAL

CONSULTA

1: Postgrad Med  2002 Jul;112(1):81-2, 85-6 [Texto completo]

Identifying acute epiglottitis in adults. High degree of awareness, close monitoring are key.

Sack JL, Brock CD.

Department of Family Medicine, Medical University of South Carolina College of Medicine, 9298 Medical Plaza Dr, Charleston, SC 29406, USA. sackjl@musc.edu

Epiglottitis can be a rapidly fatal condition in adults. Important clues that should raise clinical suspicion include the tripod sign, fever, stridor, sore throat, odynophagia, shortness of breath, and drooling. These features must be differentiated from those associated with common viral infections. The most helpful diagnostic studies are radiography of the neck and direct laryngoscopy. The patient's airway should be monitored during evaluation to avoid obstruction. Successful management requires teamwork between the primary care physician and personnel skilled in intubation as well as timely consultation with an otolaryngologist. Laryngoscopy and intubation always should be performed by the most skilled personnel because repeated attempts may increase periepiglottal swelling and the risk of airway obstruction. Racemic epinephrine should be avoided because of the rebound effect. Awareness of the possibility of epiglottitis in adults and close monitoring of the airway are the keys to management of this potentially life-threatening condition.

Publication Types:

Review

2: Eur J Emerg Med  2002 Jun;9(2):167-9

Adult acute epiglottitis and foreign body in the throat - chicken or egg?

Chung CH.

Accident and Emergency Department, North District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong SAR, China.

A 53 year old man presented with the chief complaint of having a fish bone stuck in the throat for about 1 h. There was no dysphagia or respiratory symptoms. Plain lateral neck X-ray, direct laryngoscopy and oesophagogastroduodenoscopy showed a grossly swollen epiglottis with narrowing of the laryngeal lumen. No foreign body was found. His condition improved rapidly with intravenous antibiotic therapy. As acute epiglottitis may be a sudden life-threatening condition, a high index of suspicion should be maintained for patients who present with alleged foreign bodies in the throat.

3: Ann Allergy Asthma Immunol  2002 May;88(5):513-7

Recurrent acute epiglottitis in adults: defective antibody response.

Gagnon R, Bedard PM, Cote L, Lavoie A, Hebert J.

Allergy and Immunology Department, Centre Hospitalier Universite Laval, Sainte-Foy, Quebec, Canada.

BACKGROUND: Recurrent acute epiglottitis is uncommon in adults. In the medical literature, very little is known about the immune status of this population. OBJECTIVE: To evaluate the immune system of a group of four adult patients with recurrent acute epiglottitis, in what represents the largest series ever reported. METHODS: The clinical course of these episodes was carefully evaluated and a basic immune deficiency work-up was carried out for each patient. RESULTS: All four patients displayed clinical and laboratory evidence of impaired humoral immunity. One patient was splenectomized. Another patient had a below normal immunoglobulin G level. At the time of their first evaluation, none of our patients had specific antibodies against Haemophilus influenzae and one had a subnormal Streptococcus pneumoniae immunoglobulin G level for a majority of serotypes. After specific vaccination, two patients had persistent abnormalities in their response to one or more polysaccharides or conjugate-polysaccharide antigens. In the other two, the transient abnormalities were corrected by immunization. CONCLUSIONS: When recurrent acute epiglottitis occurs in adults, it is important to investigate the immune system because a quantitative or a specific antibody deficiency could be found. It also follows that these patients will be successfully treated either by immunization or antibody replacement.

4: J Laryngol Otol  2001 Jan;115(1):31-4

Acute epiglottitis: a review of 80 patients.

Nakamura H, Tanaka H, Matsuda A, Fukushima E, Hasegawa M.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyorin University, Tokyo, Japan.

We reviewed 80 patients admitted to our hospital who were diagnosed with acute epiglottitis between January 1995 and March 1999, and their clinical features, evolution and treatments were analysed. No sexual predominance was found, and there was no patient younger than 16 years of age. The patient fatality rate was 1.3 per cent, and the hospitalization period was markedly longer than those of other reports.

5: An Otorrinolaringol Ibero Am  2000;27(2):177-84

Acute epiglottitis in the adult. Retrospective study of 14 cases

[Article in Spanish]

Damborenea Tajada J, De Miguel Garcia F, Naya Galvez MJ, Campos del Alamo MA, Martinez Berganza R, Marin Garrido C, Ortiz Garcia A.

Servicio de O.R.L., Hospital Miguel Servet de Zaragoza.

Acute epiglottitis instead of been a well recognised disease in children, is a rare condition in adult patients. Failure to diagnose epiglottitis early, in adults, undoubtedly contributes to its continuing mortality. We report our experience with acute epiglottitis in grown-up people with a retrospective series of 14 patients seen in our Department from 1993 to 1997. We comment about clinical features and therapeutic management of these patients.

6: Hosp Pract (Off Ed)  1998 Dec 15;33(12):117

Case in point. Acute epiglottitis with subcutaneous emphysema.

Varadarajulu S, Israel R.

Department of Internal Medicine, St. Mary's Hospital, Rochester, N.Y., USA.

7: Am J Emerg Med  1996 Jul;14(4):421-4

Epiglottitis in adults.

Carey MJ.

Veterans Affairs Medical Center, Seattle, WA 98144, USA.

Acute epiglottitis has become a disease of adults, probably as a result of immunization of children against Haemophilus influenzae. This article is a review of the literature on epiglottitis, including signs and symptoms, investigation, differential diagnosis, and treatment in the emergency department. The microbiology is discussed and the importance of prophylaxis in exposed persons is stressed.

Publication Types:

Review

8: Scand J Infect Dis  1996;28(3):261-4

Incidence, aetiology, and prognosis of acute epiglottitis in children and adults in Sweden.

Berg S, Trollfors B, Nylen O, Hugosson S, Prellner K, Carenfelt C.

Department of Paediatrics, Molndal Hospital, Sweden.

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature > or = 38 degrees C. A total of 306 children and adolescents (0-19 years) and 502 adults (> or = 20 years) were found. The age-specific incidence was highest in children aged 0-4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0-19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981-83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.