Epiglottitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Epiglottitis may be classified according to the etiology, and disease duration into infectious and noninfectious causes. Infectious epiglottitis may be subclassified into bacterial, viral and fungal causes. Noninfectious epiglottitis is main due to trauma from foreign objects inhalation and chemical burns[1] On the basis of disease duration, epiglottitis is almost always acute in presentation requiring emergency treatment else the outcome is fatal.[2]

Classification

Epiglottitis is almost always an acute condition and may be classified according to the etiology of the disease.

Etiological classification

1. Infectious epiglottitis

Infectious epiglottitis is a soft tissue swelling of epiglottis,[3] and the surrounding structures example; plica aryepiglottica, arytenoids, sinus piriformis and vestibular folds usually caused by bacteria and occasionally viruses.[4] Infectious epiglottitis may be subclassified into:

Bacterial epiglottitis

Prior to the introduction of Haemophilus influenza type b vaccine,[5] H. influenza was the most common culprit of epiglottitis. In recent literature, group A [beta]-hemolytic Streptococci is more commonly observed to be the cause. The disease used to be mostly found in pediatric age group of 3 to 5 years. However, recent trend favors adults as most commonly affected individuals.[6] Other pathogens such as escherichia coli, kingella kingae may be encountered in immunocompromised hosts. Other common bacterial causes of epiglottitis include:[7][8][9] Staphylococcus aureus and Streptococcus pneumoniae.

Viral epiglottitis

This mostly happen in immunocompromised people commonly resulting in necrotizing epiglottitis usually involving infection with CMV or EBV. Affected patients are usually neutropenic and lymphopenic at presentation. CMV and EBV modulate the host's immune defense facilitating immune evasion and thereby predisposing the patient to superimposed infections. The causative organism of necrotizing epiglottitis is unclear.[10]

Fungal epiglottitis

Fungi are rare cause of epiglottitis. Notable among them are aspergillus spp and candida albicans.[1]

2. Noninfectious epiglottitis

This includes all other factors resulting in the development of epiglottitis aside pathogenic organism. These include trauma from foreign objects inhalation and chemical burns[1]

References

  1. 1.0 1.1 1.2 Charles R, Fadden M, Brook J (2013). "Acute epiglottitis". BMJ. 347: f5235. doi:10.1136/bmj.f5235. PMID 24052580.
  2. Mathoera RB, Wever PC, van Dorsten FR, Balter SG, de Jager CP (2008). "Epiglottitis in the adult patient". Neth J Med. 66 (9): 373–7. PMID 18931398.
  3. Shah RK, Stocks C (2010). "Epiglottitis in the United States: national trends, variances, prognosis, and management". Laryngoscope. 120 (6): 1256–62. doi:10.1002/lary.20921. PMID 20513048.
  4. Ossoff RH, Wolff AP, Ballenger JJ (1980). "Acute epiglottitis in adults: experience with fifteen cases". Laryngoscope. 90 (7 Pt 1): 1155–61. PMID 6967138.
  5. Schlossberg, David (2015). Clinical infectious disease (Second ed.). p. 202. ISBN 9781107038912.
  6. Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
  7. Trollfors B, Nylén O, Strangert K (1990). "Acute epiglottitis in children and adults in Sweden 1981-3". Arch Dis Child. 65 (5): 491–4. PMC 1792127. PMID 2357085.
  8. Lichtor JL, Roche Rodriguez M, Aaronson NL, Spock T, Goodman TR, Baum ED (2016). "Epiglottitis: It Hasn't Gone Away". Anesthesiology. 124 (6): 1404–7. doi:10.1097/ALN.0000000000001125. PMID 27031010.
  9. Shah KM, Carswell KN, Paradise Black NM (2016). "Prolonged Stridor and Epiglottitis With Concurrent Bacterial and Viral Etiologies". Clin Pediatr (Phila). 55 (1): 91–2. doi:10.1177/0009922815584221. PMID 25926662.
  10. Tebruegge M, Connell T, Kong K, Marks M, Curtis N (2009). "Necrotizing epiglottitis in an infant: an unusual first presentation of human immunodeficiency virus infection". Pediatr Infect Dis J. 28 (2): 164–6. doi:10.1097/INF.0b013e318187a869. PMID 19106777.

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