Detection of Main Causative Agents among Young Children Suffering from Epiglottitis in Hilla City, Iraq.

Epiglottitis is a rapidly progressive epiglottis infection leading to upper airway edema. This study aimed to detect the main causative agent, viral infection, by immunofluorescence antibody technique and PCR technique and bacterial infection detection by specific gene among young children suffering from epiglottitis. This study included 85 young children aged 10-15 years. The virus was identified on 85 blood samples using the CER test Human simplex virus Card test; the results revealed that 12 (14.1%) specimens were related to virus infection, and the sera of patients showed anti-IgM to HSV-1 antibodies. HSV-1 was detected in blood samples by qPCR technique. Eighty-five saliva samples were collected from young children suffering from epiglottitis. The samples were cultured for 18-24 hours at 37°C. They were then cultivated for 18-24 hours on various selective media at 37°C. The colony morphology, microscopically, and biochemical testing were used to identify Haemophilus influenzae as a first Identification. Out of 85 clinical specimens, 63 (74.1%) were positive culture, while 22 (25.9%) had no growth on culture media; out of 63 specimens, only 22 (34.9%) isolates belonged to Haemophilus influenzae by biochemical tests, while 41 (65.1%) related to other types of microorganisms. VITEK 2 was used to validate bacteria isolates from young children suffering from epiglottitis. The findings indicate that 22 (34.9%) isolates related to Haemophilus influenzae have been confirmed with an excellent ID message confidence level (94 to 99.8% likelihood percentage). This method is characterized by quick bacterial detection. DNA was taken from all suspected isolates previously identified as Haemophilus influenzae using the vitek2 technology, and traditional PCR was used to amplify specific hel gene for Haemophilus influenzae primers utilizing these DNA samples. After that, when compared to an allelic ladder, gel electrophoresis revealed that all 22 (100%) samples of Haemophilus influenzae produced 101 bp DNA fragments. For isolates previously identified as Haemophilus influenzae, molecular identification of the ompP gene was performed. The results showed that 12 (or 54.5 percent) of the 22 isolates tested positive for this virulence gene. When compared to an allelic ladder, the presence of (459 bp) bands indicated positive results. In addition, the bexA gene was molecularly detected in 22 Haemophilus influenzae isolates, showing that only 8 (36.3 percent) of the isolates had this gene. When compared to an allelic ladder, the presence of a (343 bp) band indicated positive results for bexA gene pathogenicity; in conclusion, HSV (1) and Hib were considered almost causative agents of epiglottitis in young children.

Infection and sudden lethal upper airway occlusion - An overview.

A multitude of conditions may cause acute and unexpected upper airway compromise in both children and adults. These include mechanical blockage of the airways either from internal obstructions due to inhaled food or foreign objects, or from external compression. In addition, kinking of the airway in cases of positional asphyxia may compromise aeration. Infections represent another cause of airway narrowing with the potential for occlusion. The case of a 64-year-old man with acute laryngo-epiglottitis is used to demonstrate that death may occur from infections in previously structurally-normal airways. Infections may compromise respiration due to acute airway occlusion from intraluminal material/mucus, mural abscesses or from acutely inflamed and oedematous mucosa with adherent tenacious mucopurulent secretions. External compression from nearby abscesses may also critically narrow air passages.

Early intervention of transoral laser-assisted marsupialization for adult epiglottic abscess.

Epiglottic abscess is a potentially fatal disease by airway compromise. Emergent airway intervention and admission to an intensive care unit are frequently required for patients with epiglottic abscess. Epiglottic abscess also doubles the duration of hospitalization compared to non-abscess epiglottitis. Abscess drainage, antibiotics administration, and airway monitoring are the mainstays of treatment. Spinal needle aspiration has been introduced to treat epiglottic abscess, which shows no significant additional benefit from a comparative study. Marsupialization has been commonly utilized to treat benign cystic diseases. Early surgical intervention of epiglottic abscess may resolve patient symptoms and secure the airway. Early intervention of transoral laser-assisted marsupialization for epiglottic abscess was a safe, simple, and reliable technique that guaranteed early recovery in 12 cases. Therefore, this article presents the procedures, pros, and cons of this method for treating epiglottic abscess.

Acute epiglottitis caused by COVID-19: A systematic review.

The COVID-19 pandemic has caused substantial population infections worldwide. COVID-19 has been reported to cause acute epiglottitis (AE); nonetheless, COVID-19-related AE is poorly understood by healthcare workers because of the disease's low occurrence. This systematic review aimed to improve knowledge of the clinical characteristics of COVID-19-related AE. We conducted a comprehensive search of the literature databases PubMed, Web of Science, Embase, and Scopus, using various keywords and descriptors such as "COVID-19," "SARS-CoV-2," and "AE" in combination with the AND/OR operator. This review included 11 patients with COVID-19-related AE, all of whom were adults except for one 15-year-old girl. COVID-19-related AE was more prevalent in males, who accounted for 81.8% of patients. Patients with COVID-19-related AE experienced symptoms such as hoarseness, dysphagia, odynophagia, sore throat, and dyspnea. Hoarseness may be one of the typical symptoms of COVID-19-related AE. Five patients with COVID-19-related AE had coexisting diseases, including hypertension, obesity, diabetes, obstructive sleep apnea, Wolff-Parkinson-White syndrome, and intracranial tumors. Antibiotics and steroids were commonly administered. Five patients with COVID-19-related AE underwent intubation and cricothyroidotomy airway management. Due to the low success rate of intubation, emergency tracheotomy is the recommended option for patients with COVID-19-related AE who present with more severe dyspnea. AE could be an uncommon manifestation of COVID-19, and SARS-CoV-2 infection should be considered as a possible cause of AE. Healthcare workers should be vigilant in recognizing COVID-19-related AE.

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.

Using Transfer Learning of Convolutional Neural Network on Neck Radiographs to Identify Acute Epiglottitis.

Acute epiglottitis (AE) is a life-threatening condition and needs to be recognized timely. Diagnosis of AE with a lateral neck radiograph yields poor reliability and sensitivity. Convolutional neural networks (CNN) are powerful tools to assist the analysis of medical images. This study aimed to develop an artificial intelligence model using CNN-based transfer learning to identify AE in lateral neck radiographs. All cases in this study are from two hospitals, a medical center, and a local teaching hospital in Taiwan. In this retrospective study, we collected 251 lateral neck radiographs of patients with AE and 936 individuals without AE. Neck radiographs obtained from patients without and with AE were used as the input for model transfer learning in a pre-trained CNN including Inception V3, Densenet201, Resnet101, VGG19, and Inception V2 to select the optimal model. We used five-fold cross-validation to estimate the performance of the selected model. The confusion matrix of the final model was analyzed. We found that Inception V3 yielded the best results as the optimal model among all pre-train models. Based on the average value of the fivefold cross-validation, the confusion metrics were obtained: accuracy = 0.92, precision = 0.94, recall = 0.90, and area under the curve (AUC) = 0.96. Using the Inception V3-based model can provide an excellent performance to identify AE based on radiographic images. We suggest using the CNN-based model which can offer a non-invasive, accurate, and fast diagnostic method for AE in the future.

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.

Association Between Systemic Corticosteroid Use and Mortality in Patients with Epiglottitis.

OBJECTIVES: To clarify whether treatment with systemic corticosteroids at a certain dose was associated with better outcomes in patients with epiglottitis requiring airway management (tracheotomy or airway intubation). METHODS: This was a retrospective cohort study on patients hospitalized for epiglottitis requiring airway management from a nationwide inpatient database (between July 2010 and March 2019). Patients treated with systemic corticosteroids equivalent to methylprednisolone ≥40 mg/d within 2 days of admission and patients who were not treated with corticosteroids within 2 days of admission were compared after inverse probability of treatment weighting using covariate balancing propensity score. The primary outcome was all-cause 30-day in-hospital mortality, and secondary outcomes included all-cause 7-day in-hospital mortality, length of hospital stay, and total medical cost. RESULTS: There were 1986 and 1771 patients in the corticosteroid and control groups, respectively. A total of 72 of 3757 (1.9%) patients died within 30 days of admission, including 17 of 1986 (0.9%) patients in the corticosteroid group and 55 of 1771 (3.1%) in the control group (weighted odds ratio, 0.28 [95% confidence interval, 0.11-0.70]; weighted risk difference, -2.2% [-3.2% to -1.3%]). Treatment with corticosteroids was associated with lower total medical costs (weighted median, $6,187 vs. $6,587; weighted difference, $-1,123 [-2,238 to -8]) but not all-cause 7-day in-hospital mortality (weighted odds ratio, 0.63 [0.22-1.82]; weighted risk difference, -0.3% [-0.9 to 0.2]) and length of hospital stay (weighted median, 13 vs. 13 days; weighted difference, -0.2 days [-2.1 to 1.8]). CONCLUSIONS: Systemic corticosteroids may be beneficial to patients with epiglottitis requiring airway management. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:344-349, 2023.

[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.

Elevated risk of acute epiglottitis in patients with chronic obstructive pulmonary disease: A nationwide cohort study.

OBJECTIVE: In individuals with epiglottitis, chronic obstructive pulmonary disease (COPD) is a common comorbidity; however, the impact of COPD under such circumstances is not well documented. Therefore, we performed this population-based study to determine whether, in adults, COPD is a risk factor for epiglottitis. METHODS: In this retrospective matched-cohort study, data obtained from the Taiwan National Health Insurance Research Database were analyzed. We identified all patients newly diagnosed as having COPD in 2000-2011 and performed frequency matching and propensity-score matching for every patient with COPD individually to another patient without a COPD diagnosis. We used epiglottitis occurrence as the study endpoint, and we investigated the hazard ratio of epiglottitis by using the Cox proportional hazards model after adjustment for potential confounders. RESULTS: In the frequency matching, the cumulative epiglottitis incidence was significantly higher (p = 0.005) in the COPD cohort. According to the adjusted Cox proportional hazard model, COPD exhibited a significant association with elevated epiglottitis incidence (adjusted hazard ratio: 1.76; 95% confidence interval: 1.15-2.70, p = 0.009). Similar trend was observed in the propensity-score matching analysis (adjusted hazard ratio: 1.50; 95% confidence interval: 0.99-2.29, p = 0.057). Our subgroup analysis revealed COPD to be an epiglottitis risk factor in male patients and those aged 40-64 years. CONCLUSIONS: This is the first nationwide matched-cohort research to examine the association of COPD with epiglottitis. Our results revealed that COPD may be a potential risk factor for epiglottitis; thus, clinicians should be mindful of the potential increased risk of epiglottitis following COPD.