Epiglottitis
| Classification according to ICD-10 | |
|---|---|
| J05.1 | Acute epiglottitis |
| ICD-10 online (WHO version 2019) | |
The epiglottitis or laryngitis supraglottica is a life threatening epiglottitis , ( epiglottis = gr. Epiglottis, itis = inflammation) and is mostly by the bacterium influenzae Haemophilus type B causes. Epiglottitis affects children between the ages of two and six more often than adults and is characterized by severe pain when swallowing, lumpy speech, shortness of breath and high fever.
Epiglottitis is an emergency. If epiglottitis is suspected, it is usually necessary to be transported to a clinic by the ambulance service accompanied by an emergency doctor. Vaccination against the cause of epiglottitis (Haemophilus influenzae) is possible and recommended by the STIKO .
Occurrence
Epiglottitis occurs more frequently in small children and school children between the ages of two and six years and is therefore counted among the childhood diseases. But adolescents and adults can also be affected. In most cases the disease breaks out without a previous illness, only sometimes after previous infections of the upper nasopharynx. Due to the good vaccination protection since the introduction of the recommended Haemophilus influenza type b vaccination (so-called Hib vaccination), it is rarely found, but extremely dangerous due to its mostly acute to fatal occurrence ( lethality 10% - 20%) .
Symptoms
The main symptoms of acute epiglottitis are sudden onset of high fever (38–40 ° C), severe swallowing pain and the resulting refusal to eat and increased salivation. Since the epiglottis and larynx are extremely swollen and the airway is severely narrowed, those affected find it difficult to breathe. Typical (similar to the Krupp syndrome ) is a pronounced inspiratory stridor with coughing and a "creaking" (similar to snoring) exhalation. The epiglottis appears as a plump, crimson ball. Abscesses are also possible; they appear as bulging yellow spots on the swollen epiglottis. Patients try by all means to improve the air supply. The mouth is open, the patients are usually very concentrated and use the driver's seat to make better use of the auxiliary breathing muscles . Some patients also show distinct perioral pallor or even cyanosis . The language sounds lumpy. In extreme cases, attacks of suffocation occur , which can lead to death. Overall, the course of the disease is very rapid, usually in full health within hours of extreme deterioration of the condition. The patients appear seriously ill.
Pathogen
Haemophilus influenzae , also known as Pfeiffer influenza bacteria, is the main causative agent of epiglottitis. It is a gram-negative , facultative anaerobic rod-shaped bacterium, partially encapsulated and immobile. Rare pathogens are Streptococcus pneumoniae , other beta-hemolytic streptococci and Staphylococcus aureus .
Procedure and treatment
If acute epiglottitis is even suspected, immediate transport to a hospital is necessary. If possible, an instrumental examination of the pharynx should be avoided, as any manipulation of the swollen mucous membrane can lead to a complete obstruction of the upper airways and trigger a reflex laryngospasm . The instrumental inspection of the pharynx may only be carried out with available options for securing the airway (see below). The patient must be handled very carefully, as any kind of additional stress can worsen breathing. The administration of benzodiazepines (e.g. diazepam ) is dangerous because, in addition to the desired sedation , respiratory depression can also occur.
Drug therapy with corticosteroids (e.g. prednisone ) should be started as soon as possible in order to rapidly reduce the swelling of the epiglottis. Due to the late onset of action of corticosteroids, nebulization of adrenaline is also an option to achieve rapid decongestion. At the same time, high-dose intravenous antibiotics should be administered (e.g. with cephalosporins of the 2nd or 3rd generation; cefuroxime or ceftriaxone ). Breathing must be monitored ( pulse oximetry ), in extreme emergencies it must be secured by endotracheal intubation , which can be difficult due to the symptoms described above in the case of purulent swollen epiglottis. For this reason, in addition to endotracheal intubation, surgical intervention ( cricothyrotomy , tracheotomy ) should also be prepared.
prevention
Vaccination against the cause of epiglottitis ( Haemophilus influenzae ) is possible (see HIB vaccination ). This is recommended for all small children (official recommendation from STIKO ).
Similar diseases
A disease with similar symptoms ( differential diagnosis ) is acute subglottic laryngitis , the so-called pseudo croup . This is similar to epiglottitis, but there are some differences:
- No swallowing pain
- Typical barking cough
- The fever does not rise as high (rarely above 38 ° C).
- Those affected are mostly younger (children aged 1–3 years).
- Very rarely fatal outcome.
Nevertheless, it is difficult to differentiate between the two diseases in individual cases.
Other diseases with a similar course are:
- Diphtheria : If the larynx is affected (true croup), there is also difficulty breathing with sound of stenosis (stridor), death by suffocation is possible. Diphtheria occurs extremely rarely in the Federal Republic of Germany .
- Foreign body aspiration : Most common in young children. Suddenly out of nowhere cough and shortness of breath. No fever, no other signs of infection.
Individual evidence
- ↑ J. Kaufmann, M. Laschat, F. Wappler: Preclinical care of child emergencies. In: Anaesthesiology & Intensive Care Medicine. Volume 61, 2020, pp. 26–37, here: p. 33.
