Brief overview
- Symptoms: Sudden onset of illness, severe feeling of illness, slurred speech, swallowing hurts or is not possible, salivation, shortness of breath and choking suddenly occur (medical emergency)
- Causes and risk factors: Mostly infection with the bacterium Haemophilus influenza type B, more rarely Streptococcus pneumoniae or Staphylococcus aureus; insufficient vaccination against HiB is a risk factor, especially in adults.
- Diagnosis: visual diagnosis by physician, as few further examinations as possible to avoid choking, artificial respiration or tracheotomy prepared on an emergency basis, rarely tracheoscopy
- Treatment: Usually artificial respiration, antibiotic administration via the bloodstream against the bacteria, administration of cortisone preparations to contain the inflammation
- Prognosis: Treated usually cure after a few days without consequences, choking attacks end fatally in ten to 20 percent of cases
Brief overview
Symptoms: Sudden onset of illness, severe feeling of illness, slurred speech, swallowing hurts or is not possible, salivation, shortness of breath and choking suddenly occur (medical emergency)
Causes and risk factors: Mostly infection with the bacterium Haemophilus influenza type B, more rarely Streptococcus pneumoniae or Staphylococcus aureus; insufficient vaccination against HiB is a risk factor, especially in adults.
Diagnosis: visual diagnosis by physician, as few further examinations as possible to avoid choking, artificial respiration or tracheotomy prepared on an emergency basis, rarely tracheoscopy
Treatment: Usually artificial respiration, antibiotic administration via the bloodstream against the bacteria, administration of cortisone preparations to contain the inflammation
Prognosis: Treated usually cure after a few days without consequences, choking attacks end fatally in ten to 20 percent of cases
Overall, however, the number of cases is decreasing – epiglottitis has now become a rare disease.
A probably prominent historical victim of epiglottitis is the first president of the United States of America, George Washington.
What are the symptoms?
Epiglottitis is always an emergency. This is because acute respiratory distress often develops within a very short time of six to twelve hours after the onset of illness. Therefore, call an emergency physician immediately, even if it turns out that the symptoms may have been triggered by another illness.
Epiglottitis is likely to be present if the following symptoms are present:
- The affected person appears very ill and complains of severe sore throat when speaking.
- The fever is over 39 degrees Celsius and starts suddenly.
- Speech is “clotty.”
- Swallowing is usually no longer possible.
- The lymph nodes in the neck are swollen.
- Some patients do not want to speak or are unable to do so.
- Breathing is difficult and sounds like snoring (raspy breathing). This is partly because a salivary lake has formed in the throat.
- The jaw is stretched forward and the mouth is open.
- The sitting posture of the affected person is bent forward, while the head is tilted backward (coachman’s seat), because breathing is easier that way. Affected persons refuse to lie down.
- Patients are pale and/or blue in color.
- Increasing shortness of breath
Life-threatening choking is possible with epiglottitis – in this case, call an ambulance and an emergency physician immediately!
Differentiation between epiglottitis and pseudocroup
However, while epiglottitis is a life-threatening condition, pseudocroup is usually harmless. The following differences exist:
|
Epiglottitis |
Pseudocroup |
|
|
Pathogen |
Mostly the bacterium Haemophilus influenzae type B |
Mostly viruses, e.g. the parainfluenza virus |
|
General condition |
Severe illness, high fever |
Usually not significantly affected |
|
Onset of the disease |
Suddenly out of best health, rapidly getting worse |
Slow, increasing onset of disease |
|
Typical features |
Potty language, severe swallowing difficulties, affected persons are unable to swallow their own saliva |
Barking cough, hoarseness, especially at night, but no difficulty in swallowing |
Epiglottitis does not cause hoarseness or coughing.
Causes and risk factors
In some cases, sufferers have a trivial infection before epiglottitis, such as a cold or mild sore throat. In most cases, however, sufferers fall ill out of perfect, perfect health. Unlike pseudocroup, which is much more common, epiglottitis does not have a seasonal incidence; epiglottitis occurs at all times of the year.
Haemophilus influenzae type B
The bacterium Haemophilus influenzae type B, which causes epiglottitis, colonizes the mucous membrane of the respiratory tract (nose, throat, trachea) and may cause inflammation there. It is transmitted by coughing, talking or sneezing (droplet infection).
The incubation period, i.e. the time between infection and the first symptoms, is two to five days. In the past, the bacterium was mistakenly thought to be the cause of influenza and was therefore called “influenzae”.
Examinations and diagnosis
The physician performs a physical examination only if there are no breathing difficulties yet. Equipment for artificial respiration and at least administration of oxygen must always be ready in case they develop.
The doctor then inspects the oral cavity and pharynx with a spatula. In children, the inflamed epiglottis can be seen by gently pushing away the tongue.
If necessary, a laryngoscopy or a tracheoscopy and bronchoscopy is required. The epiglottis is noticeably red and swollen.
If the patient is gasping for breath and has a blue tinge (cyanosis), artificial respiration (intubation) is recommended at an early stage. To do this, a breathing tube is placed in the throat via the mouth or nose to secure the airway.
How is epiglottitis treated?
Epiglottitis is treated as an inpatient and with intensive care. In the hospital, the patient is closely monitored and, if necessary, artificially ventilated. Infusions via a vein supply him with nutrients and regulate the fluid balance.
He also receives intravenous antibiotics such as cefotaxime or cephalosporins over a period of ten days. Furthermore, the treating physicians give cortisone (glucocorticoid) via the vein so that the inflammation of the epiglottis decreases. A pump spray with epinephrine helps to relieve acute respiratory distress.
If respiratory arrest is imminent, the affected person is intubated immediately, which may be difficult because of the epiglottitis. In addition, an adrenaline spray is administered.
As a rule, the patient is artificially ventilated for about two days. He is not discharged until no more complaints have occurred for more than 24 hours.
Measures to be taken until the emergency doctor arrives
Until the emergency physician arrives, you should calm the patient in case of epiglottitis, because unnecessary excitement often worsens the shortness of breath. Therefore, do not attempt to look down the throat under any circumstances.
Open the windows to provide fresh air. Open constricting clothing. Pay attention to the posture the sufferer wants to adopt.
The coachman’s seat with the trunk bent forward, arms supported on the thighs and the head turned upward often facilitates breathing.
Course of the disease and prognosis
With timely therapy, symptoms improve within a few days, and epiglottitis heals without sequelae. If epiglottitis is recognized or treated too late, it may be fatal.
Prevention
Since the bacterium Haemophilus influenzae type B is predominantly the trigger of epiglottitis, the so-called HiB vaccination provides effective protection.
The Permanent Vaccination Commission (STIKO) of the Robert Koch Institute (RKI) recommends vaccination for all infants from the second month of life. It is usually given as a six vaccination together with vaccines against hepatitis B, tetanus, diphtheria, polio and pertussis.
According to the reduced 2+1 vaccination schedule recommended by the STIKO since June 2020, infants receive the HiB vaccine in the second, fourth and eleventh months of life. Premature infants, on the other hand, receive four vaccine shots (one additional in the third month of life).
Booster vaccinations are not necessary after complete basic immunization. Basic immunization is important to build up sufficient vaccine protection to effectively prevent epiglottitis.
For more on vaccination against Haemophilus influenzae type B, see our article Hib vaccination.