RESUMO
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.
Assuntos
Epiglotite , Neoplasias Orofaríngeas , Masculino , Humanos , Idoso , Epiglotite/complicações , Epiglotite/diagnóstico , Epiglotite/terapia , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Orofaríngeas/complicações , Neoplasias Orofaríngeas/diagnóstico , Neoplasias Orofaríngeas/terapia , Quimiorradioterapia/efeitos adversos , Traqueostomia/efeitos adversos , Antibacterianos/uso terapêuticoRESUMO
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% ï¼14/331ï¼, 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 ï¼42.9%ï¼, and dysphagia in the non-recurrent group ï¼42.0%ï¼. The frequency of drinking in recurrent group was higher than that in non-recurrent group ï¼P=0.009ï¼. The incidence of chronic obstructive pulmoriary diseaseï¼COPDï¼, 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 ï¼more than twice a weekï¼, 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.
Assuntos
Cistos , Epiglotite , Refluxo Laringofaríngeo , Doença Pulmonar Obstrutiva Crônica , Humanos , Adulto , Epiglotite/diagnóstico , Epiglotite/terapia , Fatores de Risco , Doença AgudaRESUMO
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.
Assuntos
Obstrução das Vias Respiratórias , Epiglotite , Doença Aguda , Adulto , Obstrução das Vias Respiratórias/etiologia , Criança , Epiglote , Epiglotite/diagnóstico , Epiglotite/epidemiologia , Epiglotite/terapia , Humanos , Laringoscopia/efeitos adversos , PrevalênciaRESUMO
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.
Assuntos
Epiglotite , Infecções por Haemophilus , Faringite , Estomatite , Criança , Pré-Escolar , Epiglotite/diagnóstico , Epiglotite/tratamento farmacológico , Feminino , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/tratamento farmacológico , Humanos , Streptococcus pyogenes , ÚvulaRESUMO
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.
Assuntos
COVID-19 , Epiglotite , Síndrome do Desconforto Respiratório , Doença Aguda , Epiglotite/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
OBJECTIVE: The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB). STUDY DESIGN: Retrospective case series. MATERIALS AND METHODS: Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018. RESULTS: Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients. CONCLUSIONS: Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.
Assuntos
Erros de Diagnóstico , Refluxo Laringofaríngeo/diagnóstico , Leucoplasia/diagnóstico , Mycobacterium tuberculosis , Tuberculose Laríngea/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Epiglote/patologia , Epiglotite/diagnóstico , Feminino , Humanos , Laringe/diagnóstico por imagem , Laringe/microbiologia , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose Laríngea/microbiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Prega Vocal/patologiaAssuntos
Epiglote/microbiologia , Epiglotite/diagnóstico , Mycobacterium tuberculosis , Tuberculose Laríngea/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Epiglotite/microbiologia , Humanos , Neoplasias Laríngeas/diagnóstico , Masculino , Ilustração Médica , Tuberculose Laríngea/microbiologiaRESUMO
An adolescent female patient presenting with subacute onset of dysphagia and hoarseness underwent a direct laryngoscopy, which revealed epiglottitis. After 2 hospitalizations and multiple consultations and biopsies, all infectious testing results for viral, bacterial, fungal, and acid-fast bacilli etiologies were negative. The patient's use of electronic cigarettes was the only exposure elicited with a likely role in her presentation. This case, combined with the growing body of evidence revealing the toxic effects of vaping and the increasing use of electronic cigarettes among adolescent patients, highlights the many unknowns and risks regarding the biological effects of this practice.
Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Epiglotite/induzido quimicamente , Vaping/efeitos adversos , Adolescente , Transtornos de Deglutição/etiologia , Epiglotite/diagnóstico , Feminino , Rouquidão/etiologia , Humanos , LaringoscopiaRESUMO
La epiglotitis aguda infecciosa es infrecuente en la actualidad, debido a la vacunación contra su principal agente etiológico, el Haemophilus influenzae b. Se requiere alto índice de sospecha ante el cuadro clínico de dificultad respiratoria, estridor, disfonía y fiebre. Se presenta a un niño de 2 años, previamente sano, con esquema de vacunas completas, con dificultad respiratoria aguda y estridor laríngeo, en el que, al momento de realizar la intubación, se realizó el diagnóstico de epiglotitis aguda. Con hemocultivos positivos para Haemophilus influenzae b, cumplió 13 días de tratamiento con ceftriaxona, con hemocultivos de control y cultivo de líquido cefalorraquídeo negativo.
Acute infectious epiglottitis is infrequent at present due to vaccination for its main etiologic agent, Haemophilus influenzae b (Hib). It must be taken into account when we make a differential diagnosis in a child whose clinical symptoms are respiratory distress, stridor, dysphonia and fever. We report a 2-year-old child, previously healthy, whose vaccination calendar was complete, and whose clinical presentation included respiratory distress and stridor; at the moment of the intubation the laryngoscopy showed an acute epiglottitis. Blood cultures were taken, which were positive for Hib. He was treated with ceftriaxone during 13 days, and the control blood cultures and cerebrospinal fluid were negative.
Assuntos
Humanos , Masculino , Pré-Escolar , Haemophilus influenzae tipo b , Epiglotite/diagnóstico , Ceftriaxona/uso terapêutico , Sons Respiratórios , Vacinas Anti-Haemophilus , Epiglotite/tratamento farmacológicoRESUMO
We present a case of acute Candida epiglottitis in an otherwise healthy and Haemophilus influenzae type B-immunized 4-year-old child. A query of the literature reveals this disease to be commonly found in patients who are immunocompromised by problems including human immunodeficiency virus disease and lymphoma and leukemia. However, there are no published reports of acute Candida epiglottitis in immunocompetent and vaccinated patients. Our case should emphasize to the emergency physician the need to remain vigilant for subtle and atypical presentations of airway-destabilizing diseases.
Assuntos
Candidíase/diagnóstico , Epiglotite/diagnóstico , Doença Aguda , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Pré-Escolar , Endoscopia/métodos , Epiglotite/tratamento farmacológico , Epiglotite/microbiologia , Feminino , Humanos , ImunocompetênciaRESUMO
BACKGROUND: The type of scalding injury known as 'teapot syndrome', where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection. CASE PRESENTATION: We report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn. CONCLUSIONS: Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation.
Assuntos
Queimaduras/diagnóstico , Epiglote/patologia , Epiglotite/diagnóstico , Laringoscopia/métodos , Queimaduras/complicações , Epiglotite/etiologia , Humanos , Lactente , Masculino , Transtornos Respiratórios/etiologiaRESUMO
BACKGROUND: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. METHODS: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. RESULTS: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. CONCLUSION: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.
Assuntos
Cápsulas Bacterianas , Epiglotite/prevenção & controle , Vacinas Anti-Haemophilus , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Manuseio das Vias Aéreas , Austrália , Epiglotite/diagnóstico , Epiglotite/microbiologia , Epiglotite/terapia , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Epiglottitis is a rarely encountered infection in pediatrics since the advent of the conjugate Haemophilus influenzae type b vaccine first introduced in the United States in 1985. However, the disease remains a much feared infection in pediatrics. The literature reiterates the importance of early recognition, avoidance of agitating the patient, and the need for securing the airway in the operating room as key and essential features to a good outcome. However, with only 1 case per 200,000 children reported in the United States in 2006, most practitioners have never encountered this infection. The following is a case of a previously healthy and immunized child who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis.
Assuntos
Epiglotite/diagnóstico , Infecções por Haemophilus/diagnóstico , Haemophilus parainfluenzae/isolamento & purificação , Antibacterianos/uso terapêutico , Pré-Escolar , Epiglotite/tratamento farmacológico , Glucocorticoides/uso terapêutico , Infecções por Haemophilus/complicações , Infecções por Haemophilus/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva Pediátrica , Laringoscopia/métodos , Masculino , Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES: To retrospectively evaluate the diagnostic performance of qualitative and quantitative radiographic parameters for diagnosing adult acute epiglottitis, and identify the prevalence and risk factors of false-negative neck radiography-based diagnosis of acute epiglottitis. METHODS: An emergency physician and a radiologist independently reviewed neck radiographs of 91 patients with laryngoscopy-confirmed acute epiglottitis and 91 control subjects between March 2010 and June 2016 for qualitative and quantitative radiographic parameters of acute epiglottitis, and concluded a diagnosis. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of radiographic parameters, while independent risk factors of false-negative diagnosis were determined by multivariate logistic regression analysis. Inter-observer agreement was also calculated. RESULTS: All radiographic parameters showed good diagnostic performance with sensitivities and specificities of 33.0-80.2% and 64.8-100%, respectively. Epiglottis width (EW)>6.3mm showed the highest diagnostic performance (area under the ROC curve [AUC]: 0.867, sensitivity: 75.8%, specificity: 97.8%). Interobserver agreement for all radiographic parameters was excellent (range: 0.893-0.991). The lateral neck radiography-based false-negative diagnosis rate was 31.9%, and previous oral antibiotic usage was an independent risk factor of false-negative results. CONCLUSION: EW>6.3mm showed the best diagnostic accuracy, facilitating a neck radiograph-based diagnosis of acute epiglottitis. However, false-negative results on neck radiograph are quite common and previous oral antibiotic usage is a risk factor. Based on the knowledge of the usefulness and risk factors of false-negative results of neck radiography, diagnostic process for acute epiglottitis using neck radiography need to be changed.
Assuntos
Serviço Hospitalar de Emergência , Epiglote/diagnóstico por imagem , Epiglotite/diagnóstico , Laringoscopia/métodos , Radiografia/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Adulto JovemAssuntos
Cistos/diagnóstico , Doenças da Laringe/diagnóstico , Cistos/tratamento farmacológico , Cistos/patologia , Cistos/cirurgia , Diagnóstico Diferencial , Epiglotite/diagnóstico , Humanos , Doenças da Laringe/tratamento farmacológico , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Epiglottitis is a rare and life-threatening cause of acute sore throat. Usually, epiglottitis is caused by a bacterium, such as Haemophilus influenzae type b. Symptoms of epiglottitis are acute and rapidly progressive sore throat, a hoarse voice, fever, and drooling. We present two adult patients with acute sore throat who were diagnosed with epiglottitis. In adults with symptoms compatible with epiglottitis, it is justified to look down the throat with a light. Only if the view is impeded should a spatula be used but carefully. If there is a discrepancy between the severity of symptoms and few or no abnormal findings on examination of the throat, epiglottitis should be considered. If epiglottitis is suspected, referral to an ENT specialist is always indicated. Symptoms of upper airway obstruction, such as drooling, dyspnoea, inspiratory stridor and fear or anxiety, are an indication for emergency referral by ambulance.
Assuntos
Epiglotite/diagnóstico , Infecções por Haemophilus/diagnóstico , Doença Aguda , Antibacterianos/uso terapêutico , Dispneia/diagnóstico , Dispneia/microbiologia , Dispneia/terapia , Epiglotite/microbiologia , Epiglotite/terapia , Medicina Geral , Infecções por Haemophilus/tratamento farmacológico , Humanos , Intubação Intratraqueal , Laringoscopia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Sons Respiratórios , SialorreiaRESUMO
Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.
Assuntos
Infecções por Corynebacterium/microbiologia , Corynebacterium diphtheriae/isolamento & purificação , Epiglotite/microbiologia , Pré-Escolar , Infecções por Corynebacterium/diagnóstico , Epiglotite/diagnóstico , Feminino , Humanos , Hospedeiro Imunocomprometido , Testes de Sensibilidade Microbiana , NecroseRESUMO
Invasive aspergillosis is a life-threatening infection in immunocompromised hosts and occurs most frequently in the lungs. Invasive laryngeal aspergillosis is extremely rare. Due to the potential progression of invasive aspergillosis, antifungal therapy must be started immediately in cases involving clinical suspicion of the disease. A 65-year-old male with agranulocytosis complained of sore throat and dysphagia. His epiglottis was covered with caseating granulomatous lesions and the tissue was easily disrupted. A histopathological examination showed an aggressive invasion of Aspergillus species and cartilage destruction. Therefore, we made a diagnosis of primary invasive epiglottic aspergillosis. The invasive aspergillosis resolved with antifungal therapy and an increase in neutrophils. It is therefore necessary to include invasive laryngeal aspergillosis in the differential diagnosis when encountering immunocompromised patients presenting with laryngeal granulomatous lesions and laryngitis-like symptoms.
Assuntos
Aspergilose/diagnóstico , Epiglotite/diagnóstico , Hospedeiro Imunocomprometido , Aspergilose/imunologia , Epiglotite/imunologia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Abscesso/terapia , Epiglotite/terapia , Intubação Intratraqueal , Abscesso/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Terapia Combinada , Meios de Contraste , Diagnóstico Diferencial , Epiglotite/diagnóstico , Humanos , Laringoscopia , Masculino , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVES/HYPOTHESIS: The aim of the study was to evaluate the factors associated with the development of severe epiglottitis in adults to provide information for physicians to make early decisions on airway management. STUDY DESIGN: Retrospective cohort study. METHODS: Adult patients admitted to acute care hospitals with a diagnosis of acute epiglottitis between January 2011 and December 2012 were identified in the Diagnosis Procedure Combination database of Japan. The main outcome measures were: 1) severe epiglottitis requiring airway intervention or resulting in early death within 2 days after admission and 2) 2-day mortality. Multivariable logistic regression analysis was performed to evaluate the association between patient characteristics and development of severe epiglottitis. RESULTS: A total of 6,072 epiglottitis patients from 599 hospitals were identified. The proportion of developing severe epiglottitis was 9.4%, and 2-day mortality was 0.4%. Factors significantly associated with severe epiglottitis were older age, male sex (adjusted odds ratio [OR] 1.60; 95% confidence interval [CI], 1.28-2.00; P < .001), body mass index (BMI) >25.0 kg/m(2) (OR 1.31; 95% CI, 1.05-1.63; P = .018), diabetes mellitus (OR 1.41; 95% CI, 1.06-1.86; P = .017), epiglottic cyst (OR 2.90; 95% CI, 1.46-5.78; P = .002), pneumonia (OR 2.90; 95% CI, 1.73-4.86; P < .001), and academic hospitals (OR 1.56; 95% CI, 1.21-2.00; P = .001). Epiglottitis-related admission was summer-dominant, but seasonality was not significantly associated with severe epiglottitis. CONCLUSION: Development of severe epiglottitis was significantly associated with older age, BMI >25.0 kg/m(2), diabetes mellitus, epiglottic cyst, or pneumonia at admission. LEVEL OF EVIDENCE: 2b.