Pediatric thermal epiglottitis: insights from a tertiary center experience.

Thermal epiglottitis, a non-infectious cause of epiglottitis, is a rare entity that shares some clinical features with infectious epiglottitis. This study presents 16 years of experience in diagnosing and managing thermal epiglottitis. A retrospective descriptive study in a tertiary center in southern Israel included confirmed cases of thermal epiglottitis in children (0-18 years) between 2004 and 2020 by endoscopy. Of approximately 600,000 pediatric ER admissions between 2004 and 2020, seven children were diagnosed by endoscopy with thermal epiglottitis (mean age 24 months, 71% males). Clinical presentation included stridor, respiratory distress, and drooling. Four children had fever and elevated inflammatory markers at presentation and were treated with systemic antibiotics. All were treated with systemic steroids. The median length of stay in the PICU was five days, and four patients required intubations. All fully recovered without experiencing any sequelae.  Conclusion: Thermal epiglottitis stands as a potential contributor to acute upper airway obstruction. Although it's rarity, it should be discussed in any child with acute upper airway obstruction. It is essential to inquire directly about the accidental intake of hot beverages, particularly in cases lacking fever or elevated inflammatory markers. What is Known: • Thermal epiglottitis is a rare, non-infectious condition sharing clinical features with infectious epiglottitis. • Common presentations include stridor, respiratory distress, and drooling. What is New: • Thermal epiglottitis is a potential contributor to acute upper airway obstruction, urging consideration even in the absence of fever or elevated markers. • Direct inquiry about hot beverage intake for diagnosis is essential for diagnosis.

Acute Emphysematous Epiglottitis: A Case Report.

Epiglottitis is a bacterial infection of the upper respiratory tract that can be rapidly progressive and life-threatening. Though predominantly seen in unvaccinated children, there seems to be a shift with the incidence of adult cases rising following the Haemophilus Influenza B (HiB) vaccine. There are several reports of epiglottitis manifesting as an abscess, but few cases report on the formation of an emphysematous abscess. Additionally, little is known on the bacterial etiology of such infections. Here, we present a case of a patient found to have acute emphysematous epiglottis managed with fiberoptic intubation, drainage, and culture of the abscess. Laryngoscope, 133:2747-2750, 2023.

Bacterial epiglottitis superimposed on oropharyngeal cancer: A case report.

BACKGROUND: Patients undergoing chemotherapy and radiotherapy are placed in an immunocompromised state worth consideration in the event of potential airway compromise, especially when superimposed on an airway-obstructing tumor. We report a case of bacterial epiglottitis in a patient with active oropharyngeal cancer (OPC), who presented in such a way that an infectious etiology was not initially considered in the patient's care. To our knowledge, such a circumstance has not been reported in the literature. CASE: Here, we report a case of a 68-year-old male with advanced-stage OPC who developed respiratory distress and underwent emergent tracheostomy. The patient was diagnosed postoperatively with Haemophilus influenza and Pseudomonas aerugeniosa. Following antibiotic treatment, the patient recovered to the point in which he could then undergo concomitant chemoradiation. The patient later had a recurrence of P. aerugeniosa during their radiotherapy that was also treated with antibiotics. The patient experienced continued symptoms related to their OPC and underwent pharyngectomy. Despite the initial success of this procedure, the patient experienced tumor recurrence and succumbed to his disease. CONCLUSION: This case underscores the importance of considering multiple etiologies concerning airway compromise, as the consequence of delayed cancer treatment may be loss of local cancer control.

[Clinical characteristics and risk factors of recurrent acute infectious epiglottitis in adults].

Objective:The purpose of this study was to investigate the clinical characteristics and risk factors of adult recurrent acute infectious epiglottitis. Methods:All patients diagnosed with acute infectious epiglottitis hospitalized in the Department of Otolaryngology, Hai'an People's Hospital, Nantong University from January 2012 to December 2019 were included. Results:The recurrence rate of 331 adult patients with acute infectious epiglottitis was 4.2% （14/331）, including 10 cases of once recurrence and 4 cases of twice recurrence. The onset time of all patients was within 48 hours. The most common main complaint in the recurrent group was sore throat （42.9%）, and dysphagia in the non-recurrent group （42.0%）. The frequency of drinking in recurrent group was higher than that in non-recurrent group （P=0.009）. The incidence of chronic obstructive pulmoriary disease（COPD）, diabetes, cyst and gastroesophageal reflux disease/laryngopharyngeal reflux disease in recurrent group was higher than that in non-recurrent group. There was no significant difference in other clinical features, treatment and prognosis between the two groups except tongue tonsil infection under laryngoscope. Multivariate analysis showed that frequent drinking （more than twice a week）, COPD, diabetes, cysts and lingual tonsillar infection were the risk factors for recurrence. Conclusion:Adult acute infectious epiglottitis has a proportion of single or multiple recurrence. Frequent drinking, COPD, diabetes, cyst and lingual tonsillar infection are the risk factors for the recurrence.

COVID-19 presenting as acute epiglottitis: A case report and literature review.

Coronavirus disease 2019 (COVID-19) occasionally causes acute laryngitis, requiring emergency treatment. Understanding the characteristic laryngeal findings can help diagnose COVID-19 earlier, prevent worsening infection, and properly manage airway obstruction. Herein, we report the case of a 44-year-old male with acute epiglottitis likely caused by COVID-19. On presentation, chest computed tomography (CT) showed no signs of pneumonia. However, the larynx had extensive necrotic-like erosive lesions resembling those of tuberculous laryngitis. COVID-19 was diagnosed by reverse-transcription polymerase chain reaction, and secondary bacterial superinfections were suspected after blood testing. The symptoms improved after administration of antibiotics (sulbactam sodium/ampicillin sodium), steroids (dexamethasone), and favipiravir. The patient developed a high fever on the sixth day of hospitalization, and pneumonia was identified on CT. Various culture tests, including tuberculosis, were negative. Thus, remdesivir was administered for COVID-19-induced pneumonia. The patient gradually recovered, was transferred to another hospital, and was discharged on the 35th day of hospitalization. Six previous case reports of COVID-19-induced acute epiglottitis suggested that acute epiglottitis preceded the onset of pneumonia. The laryngeal findings from this report may be useful for diagnosing COVID-19 that does not cause pneumonia and for bringing attention to pneumonia after a COVID-19 diagnosis.

[Acute sore throat, not always innocent]. / Acute keelpijn, niet altijd onschuldig.

Acute sore throat is one of the most common problems in general practice. It usually concerns a viral oropharyngeal infection, with good recovery within 10 days. In current guidelines, antibiotics are recommended only in exceptional situations. Although rare, potentially life-threatening complications can occur. Three case histories, on epiglottitis, peritonsillar abscess, and Lemierre syndrome, respectively, demonstrate that acute sore throat can result in severe illness. Early recognition of alarm symptoms, alertness on a complicated disease course, and clinical (re)evaluation (within 1-2 days), are essential. This contributes to the differentiation between a harmless and a serious course, given that serious conditions also have an innocent onset. We highly recommend to consult an ENT specialist when there is doubt about the seriousness of the disease, or correctness of therapy, so timely co-assessment, treatment or transfer can follow. ECMO can be a life-saving treatment when conventional therapy is insufficiently supportive.

High risk and low prevalence diseases: Adult epiglottitis.

INTRODUCTION: Adult epiglottitis is a serious condition that carries with it a high rate of morbidity and even mortality due to airway occlusion. OBJECTIVE: This review highlights the pearls and pitfalls of epiglottitis in adult patients, including diagnosis, initial resuscitation, and management in the emergency department (ED) based on current evidence. DISCUSSION: Epiglottitis is a life-threatening emergency that occurs more commonly in adults in the current medical era with vaccinations. Children present more commonly with acute respiratory distress and fever, while adults present most commonly with severe dysphagia in a subacute manner. Other symptoms may include drooling, muffled voice, and dyspnea. Streptococcus and Staphylococcus bacteria are the most common etiologies, but others include viral, fungal, caustic, thermal injuries, and autoimmune. Lateral neck radiographs assist in diagnosis, but they may be falsely negative. Visualization of the epiglottis is the key to diagnosis. Airway assessment and management are paramount, which has transitioned from direct laryngoscopy to flexible intubating endoscopy and video laryngoscopy with assistance from anesthesia and/or otolaryngology if available. Along with airway assessment, antibiotics should be administered. Corticosteroids and nebulized epinephrine are controversial but should be considered. Patients should be admitted to the intensive care setting for close airway observation or ventilatory management if intubated. CONCLUSIONS: An understanding of epiglottitis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Infective Uvulitis in a Child.

ABSTRACT: Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticosteroid. Uvulitis is usually caused by group A Streptococcus or Haemophilus influentiae, but also other bacteria can be detected. Uvulitis can be isolated, or it can occur with epiglottitis and become an emergency.

Acute epiglottitis is a rare clinical presentation of coronavirus disease 2019: a case report.

BACKGROUND: In humans, coronavirus disease 2019 (COVID-19) has a variable presentation ranging from mild self-limiting respiratory tract infections to severe acute respiratory distress syndrome. Methods: We present the case of a patient who developed acute epiglottitis after surgery for an intracranial tumour and was subsequently diagnosed with COVID-19. RESULTS: A 58-year-old female patient developed acute-onset respiratory distress on day 6 after intracranial surgery. Neck computed tomography revealed near-total airway obstruction due to severe edoema of the epiglottis and periepiglottis. The patient's SARS-CoV-2 polymerase chain reaction test was positive. Viral respiratory tract panel and sputum and blood cultures were negative. She completed the antiviral and antibacterial treatment regimens recommended by the chest disease department. CONCLUSIONS: We conclude that epiglottitis can be an unusual manifestation of COVID-19.