What is epiglottitis
Epiglottitis is an inflammatory disease of the epiglottis and its surrounding tissues, which tends to be severe and leads to the development of suffocation, the appearance of complications from various organs. In addition to swelling in the epiglottis region, this ailment reveals inflammation of the scooped-epiglottis folds, soft tissues above the arytenoid cartilages and even the uvula of the soft palate.
The epiglottis is one of the cartilages of the larynx, resembling a petal in appearance. It performs a very important function - it closes the airways at the time of swallowing and prevents food from entering the tracheal lumen.
The name "epiglottitis" comes from lat. the word "epiglottis", which translates as "epiglottis", and the suffix "-it", indicates the inflammatory nature of the disease. In the domestic literature, this disease can be found under other names - acute submucous laryngitis, laryngeal tonsillitis, phlegmonous laryngitis. Foreign authors consider it more correct to call the disease just epiglottitis, defining inflammation of the epiglottis and laryngopharynx.
Both children and adults are susceptible to this ailment. Moreover, the risk group for the development of epiglottitis includes babies from 2 to 5 years old and adult men 40 to 50 years old. The disease affects boys 1.5 - 2 times more often than girls.
Epiglottitis in the practice of a pediatrician
Causes of the disease
The main culprit for the appearance of a dangerous ailment is considered Haemophilus influenzae type b (Haemophilus influenzae type b (Hib)). It is this pathogen that is found in more than 90% of cases of epiglottitis in preschool children.
Haemophilus influenzae is an immobile rod-shaped bacterium that can form colonies on culture media containing blood. The microorganism was first described in 1892 by the German biologist Pfeiffer, who mistakenly thought it was the causative agent of the flu.
Although the viral nature of influenza was subsequently proven, the name given to scientists has remained to this day (the word "Influenza" is translated as "influenza"). Over time, the bacterium began to bear the name of the discoverer, often called the "Pfeiffer's wand".
In older children with epiglottitis, in addition to Haemophilus influenzae, other pathogens (Staphylococcus aureus, pneumococcus, hemolytic streptococci, pseudomonads) are often released. Although inflammation of the epiglottis is traditionally considered a bacterial infection, cases of illness have been reported when infected with influenza and parainfluenza viruses. Perhaps the development of fungal epiglottitis in children with various forms of immunodeficiency.
Studies show that in cases where the cause of the disease is Haemophilus influenzae, the risk of complications increases many times. Inflammation in epiglottitis caused by other pathogens is usually limited to the epiglottis region and is moderately expressed.
How does infection occur
The disease occurs when an infectious agent enters the mucous membrane of the baby's respiratory tract. The source of infection is a sick person or an asymptomatic carrier of Haemophilus influenzae.
About 90% of the adult population is healthy carriers of various strains of the bacterium Haemophilus influenzae. 5% of them have the most dangerous type of infectious agent (type b).
The pathogenic microorganism is spread by airborne droplets when talking, coughing, sneezing or kissing. Once on the mucous membrane of the baby's respiratory tract, the bacterium penetrates into the submucous layer, causing edema and signs of inflammation. The infection quickly spreads to both the epiglottis and other structures of the laryngopharynx.
In severe cases of infection, within a few hours after the first signs of the disease appear, airway stenosis may develop. The constantly growing edema pushes the epiglottis posteriorly, causing asphyxia, often fatal.
In addition, a progressive infection can spread to surrounding tissues, subcutaneous fat, muscle fibers, perichondrium with the development of phlegmons, abscesses. Once in the bloodstream, the infectious agent quickly spreads throughout the body and can cause the development of inflammation in the middle ear, lungs, joints, and meninges.
Risk factors for developing infection
Not all carriers of a dangerous microorganism know about their characteristics, most infected babies do not have any manifestations of the disease. For the development of a dangerous state, a number of conditions are necessary, a combination of risk factors.
- Epiglottis injury. Burns of the mucous membrane of the laryngopharynx due to the consumption of too hot food, exposure to chemicals, significantly "facilitate" the entry of the microorganism into the submucosa of the epiglottis. Mechanical trauma to the mucous membrane when a foreign body enters, frequent and prolonged respiratory infections also increase the risks of developing the disease.
- Features of the baby's immune system. Children suffering from chronic diseases (sickle cell anemia, lymphogranulomatosis, who have undergone perinatal encephalopathy) are more likely to develop a dangerous condition. The weakening of the protective properties of the immune system can also be observed in children who are often ill, children suffering from immunodeficiencies, and receiving chemotherapy.
- Body sensitization. Studies show that the most severe manifestations of infection occurred in children with a burdened allergic history. A tendency to hypersensitivity reactions, drug and food allergies is often observed in children with epiglottitis.
Types of epiglottitis
Depending on the severity of the pathological process in the epiglottis, experts distinguish several forms of the disease:
- hydropic;
- infiltrative;
- abscess epiglottitis.
In the event of an edematous form of inflammation of the epiglottis, the disease usually proceeds more easily. With infiltrative and abscess epiglottitis, suffocation and septic complications are more common. But do not forget that the clinical forms of the disease can consistently replace each other within a few hours.
How is inflammation of the epiglottis manifested in children
A different amount of time can elapse between the ingress of bacteria on the mucous membrane and the appearance of the patient's first complaints. Long-term carriage of the pathogenic bacillus and the onset of the disease against the background of full health is not excluded. The manifestations of the disease may differ slightly depending on the age of the baby and the nature of the inflammation in the larynx.
But with any type of epiglottitis, characteristic symptoms appear.
- Sore throat. The kid often complains of severe soreness in the throat, often unpleasant sensations spread to the neck area, radiating to the ear, the clavicle area. These manifestations are very similar to the signs of tonsillitis in children.
- Dysphagia. The child begins to refuse to eat and drink, since the process of swallowing brings him a sharp increase in sore throat.
- Salivation. Increased secretion of the salivary glands can be observed in 80% of children, especially often these manifestations are found in young children. Important! These 3 signs are observed in almost every patient with epiglottitis and constitute the classic triad of symptoms.
- Increased body temperature. Usually, the disease begins acutely when the body temperature rises sharply to 38 - 39 ° C. Often this symptom appears at night and is accompanied by a worsening of the baby's condition. The appearance of epiglottitis against the background of an existing ARVI occurs in isolated cases.
- Deterioration of the general condition. Acute epiglottitis is accompanied by severe intoxication syndrome. The child becomes weak, lethargic, and with the addition of respiratory failure, anxiety arises. The baby gets scared, starts crying and screaming, which causes a large release of mucous secretions and increased shortness of breath.
- Airway obstruction. After the appearance of the first signs of the disease before the onset of shortness of breath, asphyxia, it may take very little time, about 3 - 5 hours. Children are characterized by the rapid development of the pathological process and the transition of the disease into a state that threatens the life of the baby.
The tendency of children to suffocate is explained by the narrowness of the airways, the rapid progression of edema of the mucous membrane, increased production of mucus, which blocks the entrance to the larynx. In addition, additional narrowing of the glottis is possible with the development of stenosis, which is associated with the high elasticity of the cartilage tissue in children.
- Cough, change in tone of voice. Hoarseness is observed in more than half of babies with epiglottitis and indicates the presence of edema in the glottis. A dry, unproductive cough occurs sporadically and is usually not debilitating. The baby also notes dry and sore throat.
- The typical appearance of a child. The clinical manifestations of the disease progress rapidly, and the condition of the baby is rapidly deteriorating. The child's skin becomes pale and cold, with a grayish tinge, cold sweat appears. The kid tries to accept a position in which he feels better.
"Pose of the tripod" is considered one of the inherent symptoms of this disease. The little patient sits on the bed and rests with his hands behind the body, while the head is thrown back, and the baby is trying to swallow air with its wide open mouth. It is in this position that the lumen of the respiratory tract increases, and the baby feels some relief.
When you try to change the forced posture of the crumbs, a deterioration occurs, an attack of shortness of breath appears, difficulty breathing. It becomes especially difficult for the baby to lie on his back.
The appearance of the first signs of epiglottitis, the appearance of symptoms of respiratory failure, indicates the need for urgent hospitalization of the baby. Often, such crumbs require intensive care in the intensive care unit.
Manifestations of epiglottitis in young children
Newborns and infants under 1 year old are very rarely prone to inflammation of the epiglottis. This ailment is more typical for children from 2 to 5 years old. It is at this age that the most severe course of the disease is possible, the rapid progression of symptoms of the disease and the development of choking, septic complications.
Since the crumbs of the first years of life cannot clearly formulate their complaints, the first signs of an illness are often overlooked, and parents go to the doctor when complications have already arisen. Therefore, moms and dads should be wary of a dangerous disease and not self-medicate. At the first signs of illness, you should immediately seek qualified help.
Symptoms of epiglottitis may resemble the manifestations of false croup in children, so the baby may need a detailed examination.
How does epiglottitis manifest in adults
In adults, inflammation of the epiglottis is rare, and men suffer from this ailment more often than women. This is due to the structural features of the respiratory system and the frequent use of substances that irritate the larynx by men (smoking). Historical evidence of the danger and transience of this disease is the sudden death of US President George Washington, caused by a complication of epiglottitis.
Diagnostics
Examination and anamnesis
Observing a baby with inflammation of the epiglottis, the doctor pays attention to the child's complaints and behavior. The doctor asks the parents when the first symptoms appeared and how the clinical manifestations of the disease changed. Often the complaints presented and the severity of the condition of the crumbs indicate the development of tonsillitis, but when examining the baby's pharynx, signs of inflammation of the tonsils are not found.
The discrepancy between the clinical manifestations of the disease and the picture in the laryngopharynx is one of the frequent signs of epiglottitis. With inflammation of the epiglottis, the doctor will detect only hyperemia of the mucous membrane and an increase in salivation.
Clinical blood test
The hemogram shows signs of inflammation caused by a bacterial infectious agent - an increase in the number of lymphocytes with a shift of the formula to the left (predominance of young forms). Leukopenia - a decrease in the number of white blood cells, is less common and speaks of the depletion of the body's defenses.
Instrumental diagnostics
With the help of special devices, you can see the epiglottis and make sure that the diagnosis is correct. The best research method is the introduction of a flexible endoscope (fibrorinopharyngolaryngoscope) and determining the degree of epiglottis lesion. In the absence of a special device, it is possible to carry out direct laryngoscopy, pushing the root of the tongue to the side and considering the entrance to the larynx.
Bacteriological culture
Using this method, it is possible not only to identify the pathogen that caused the disease, but also to determine the sensitivity of the bacteria to various antibiotics. Unfortunately, it takes some time to grow colonies of microorganisms on a nutrient medium. Since the condition of the crumbs can worsen at any minute, antimicrobial drugs are chosen based on data on the most common pathogen (Haemophilus influenzae).
Therapeutic tactics
Helping a baby before hospitalization
If the crumbs show signs of a dangerous disease, you need to immediately call an ambulance and transport the baby to the department. Parents need to allow the baby to choose a comfortable position, seat the baby and calm down. Fear and painful procedures only increase airway obstruction.
Medical tactics
Most children with severe symptoms of epiglottitis end up in the intensive care unit, where there are all conditions for the provision of comprehensive care. Almost always, the airways are freed from mucus, oxygen therapy is used. In severe cases, the baby may need respiratory support with a ventilator.
A baby with epiglottitis must be antibiotic therapy... For these purposes, antimicrobial agents are usually selected from the groups of inhibitor-protected aminopenicillins or cephalosporins of the III – IV generation (Unazin, Tienam, Vancomycin, Lendacin, Cefepim) and their combinations.
The complex treatment includes the appointment of infusion therapy, immunoglobulins, sedatives and antipyretic drugs. It is possible to use inhalations of glucocorticoids and compresses on the neck area under medical supervision.
Haemophilus influenzae can cause the development of various complications - otitis media, pneumonia, meningitis, arthritis, sepsis. One of the most dangerous complications of epiglottitis is the development of asphyxia, suffocation, leading to death. But with timely and correct treatment, mortality does not exceed 1%.
Prevention
Specific prevention of epiglottitis
To prevent Hib infection, a special vaccine has been developed, which is included in the vaccination schedule. Although vaccination cannot protect from the development of epiglottitis by 100%, the risks of dangerous complications are significantly reduced in vaccinated babies.
Non-specific prophylaxis
Non-specific preventive measures include increasing the body's defenses, proper nutrition, hardening and daily walks. The baby should be protected from contact with infectious patients, this will help protect the baby from many common diseases.
Conclusion
Inflammation of the epiglottis is a dangerous, life-threatening disease. Epiglottitis in children can lead to serious complications that, if not properly treated, can be fatal. Parents need to know the main signs of the disease and understand the importance of preventive vaccinations. After all, refusal to vaccinate in some cases can cost a child's life.
