Akutní epiglotitida v éře vakcinace: analýza 41 případů

Stáhnout PDF English version

Autoři: T. Kostlivý ¹ ; P. Klail ¹; P. Škopek ¹; J. Amlerová ² ; D. Slouka ¹
Působiště autorů: Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine in Pilsen, Charles University, University Hospital in Pilsen ¹; Department of Microbiology, Faculty of Medicine in Pilsen, Charles University, University Hospital in Pilsen ²
Vyšlo v časopise: Otorinolaryngol Foniatr, 75, 2026, No. 1, pp. 54-59.
Kategorie: Původní práce
doi: https://doi.org/10.48095/ccorl202654

Souhrn

Introduction: Acute epiglottitis (AE) is a rapidly progressing, potentially life-threatening inflammation of the epiglottis. Once primarily a pediatric disease caused by Haemophilus influenzae type b, acute epiglottitis now occurs predominantly in adults due to the widespread vaccination of children. The onset is typically sudden and urgent airway intervention may be necessary. This study aimed to describe the clinical characteristics of patients, assess the occurrence of complications, and identify their potential risk factors. Methods: A single-center study included 41 patients with AE hospitalized between March 2018 and September 2023. Data on age, sex, month of diagnosis, microbiological cultures, antibiotic therapy, and the presence of complications (such as epiglottic abscess, need for airway management, and its duration) were analyzed. Results: The cohort comprised 31 men and 10 women, with a mean age of 46.7 years. Adults predominated (39 vs. 2 children). The most commonly identified pathogens were Streptococcus pyogenes, Haemophilus spp., and anaerobes. An epiglottic abscess occurred in 15 patients (36.6%), but neither age (P = 0.60) nor sex (P = 0.27) was a significant risk factor. Intubation was required in 6 cases (14.6%). A trend toward increased risk was observed in older patients and those with an abscess, though these associations did not reach statistical significance (P = 0.13 and 0.17, respectively). Conclusion: AE occurs more commonly in adults nowadays, with a shifted spectrum of causative pathogens. Airway management is necessary in a minority of patients; however, the prediction of complications remains challenging.

Klíčová slova:

acute epiglottitis – epiglottic abscess – airway management – Hib vaccine

---------------------

Zdroje

1. Shah RK, Stocks C. Epiglottitis in the United States: national trends, variances, prognosis, and management. Laryngoscope 2010; 120 (6): 1256–1262. Doi: 10.1002/lary.20921.

2. Sideris A, Holmes TR, Cumming B et al. A systematic review and meta‐analysis of predictors of airway intervention in adult epiglottitis. Laryngoscope 2020; 130 (2): 465–473. Doi: 10.1002/lary.28076.

3. Hermansen MN, Schmidt JH, Krug AH et al. Low incidence of children with acute epiglottis after introduction of vaccination. Dan Med J 2014; 61 (4): A4788.

4. Nováková L. Surveillance of serious diseases caused by Haemophilus influenzae in the Czech Republic in 2009–2023. Vaccinology 2024; 18 (4): 170–175.

5. Hanna J, Brauer PR, Berson E et al. Adult epiglottitis: trends and predictors of mortality in over 30 thousand cases from 2007 to 2014. Laryngoscope 2019; 129 (5): 1107–1112. Doi: 10.1002/lary.28076.

6. Fan Z, Qiao T, Shi S et al. Epidemiology, presentation, management and outcomes of patients with acute epiglottitis –⁠ A 10-year retrospective study based on a tertiary hospital in northern China. Eur Arch Otorhinolaryngol 2025; 282 : 333–340. Doi: 10.1007/s00405-024-09042-9

7. Zdražil B, Profant M. Epiglotitída dospelých. Otorinolaryngol Foniatr 2010; 59 (2): 67–71.

8. Ho CY, Wang YC, Chin SC et al. Factors affecting patients with concurrent deep neck infection and acute epiglottitis. Diagnostics 2021; 12 (1): 29. Doi: 10.3390/diagnostics12010029.

9. Dowdy RA, Cornelius BW. Medical management of epiglottitis. Anesth Prog 2020; 67 (2): 90. Doi: 10.2344/anpr-66-04-08.

10. Penella A, Mesalles-Ruiz M, Portillo A et al. Acute infectious supraglottitis in adult population: epidemiology, management, outcomes and predictors of airway intervention. Eur Arch Otorhinolaryngol 2022; 279 (8): 4033–4041. Doi: 10.1007/s00405-022-07365-z.

11. Suzuki S, Yasunaga H, Matsui H et al. Factors associated with severe epiglottitis in adults: Analysis of a J apanese inpatient database. Laryngoscope 2015; 125 (9): 2072–2078. Doi: 10.1002/lary.25114.

12. Al-Qudah M, Shetty S, Alomari M et al. Acute adult supraglottitis: current management and treatment. South Med J 2010; 103 (8): 800–804.Doi: 10.1097/smj.0b013e3181e538d8.

13. Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epidemiology, clinical presentation, management and outcome. J Laryngol Otol 2008; 122 (8): 818–823. Doi: 10.1017/S0022215107000473.

14. Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: adult epiglottitis. Am J Emer Med 2022; 57 : 14–20. Doi: 10.1016/j.ajem.2022.04.018.

15. Cruz MGY, Almazan NA. Adult acute epiglottitis: an eight-year experience in a Philippine Tertiary Government Hospital. Phil J Otolaryngol Head Neck Surg 2016; 31 (2): 20–23. Doi: 10.32412/pjohns.v31i2.227.

16. Schnitzler N, Ridha H, Sirigiri R. Presentation and management of acute epiglottitis over a 10-year period in a rural setting: a retrospective cohort study. Aus J Otolaryngol 2025; 8. Doi: 10.21037/ajo-24-87.

17. Briem B, Thorvardsson O, Petersen H. Acute epiglottitis in Iceland 1983–2005. Aur Nas Lar 2009; 36 (1): 46–52. Doi: 10.1016/j.anl.2008.03.012.

18. Kjaerulff AMG, Rusan M, Klug TE. (2018). Clinical evaluation of intravenous ampicillin as empirical antimicrobial treatment of acute epiglottitis. Acta Otolaryngol 2018; 138 (1): 60–65. Doi: 10.1080/00016489.2017.1363912.

19. Sarkar S, Roychoudhury A, Roychaudhuri BK. Acute epiglottitis in adults –⁠ a recent review in an Indian hospital. Ind J Otolaryngol Head Neck Surg 2009; 61 : 197–199. Doi: 10.1007/s12070-009-0065-x.

20. Jan L, Boute P, Mouawad F. Pasteurella multocida acute epiglottitis. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 (2): 100–102. Doi: 10.1016/j.anorl.2020.06.008.

21. Tan S, Dornhofer K, Yang A et al. A case report of epiglottitis in an adult patient. J Ed Teach Emer Med 2022; 7 (1): V18. Doi: 10.21980/ J8QM09.

22. Ramawad HA, Seatherton R, Chineme J. (2024). Adult Epiglottitis as an Often Overlooked, Life-threatening Condition Requiring Special Airway Consideration; a Case Report. Arch Acad Emer Med 2024; 12 (1): e69. Doi: 10.22037/aaem.v12i1.2351.

23. Lee JH, Kim SI, Lee HH et al. Seasonality and Association With Climate Factors of Epiglottitis in South Korea: A Nationwide Population-Based Study. J Korean Soc Laryngol Phoniatr Logop 2023; 34 (3): 95–100. Doi: 10.22469/jkslp.2023.34.3.95.

24. Berger G, Landau T, Berger S et al. The rising incidence of adult acute epiglottitis and epiglottic abscess. Am J Otolaryngol 2003; 24 (6): 374–383. Doi: 10.1016/S0196-0709 (03) 00083-8.

25. Hindy J, Novoa R, Slovik Y et al. Epiglottic abscess as a complication of acute epiglottitis. Am J Otolaryngol 2013; 34 (4): 362–365. Doi: 10.1016/j.amjoto.2013.01.003.

26. Kim SG, Lee JH, Park DJ et al. Efficacy of spinal needle aspiration for epiglottic abscess in 90 patients with acute epiglottitis. Acta Otolaryngol 2009; 129 (7): 760–767. Doi: 10.1080/00016480802369302.

27. Sideris G, Papadimitriou N, Korres GF et al. Clinical and microbiological factors associated with abscess formation in adult acute epiglottitis. Ann Otol Rhinol Laryngol 2022; 131 (11): 1194–1201. Doi: 10.1177/00034894211051817.

28. Booth AW, Pungsornruk K, Llewellyn S et al. Airway management of adult epiglottitis: a systematic review and meta-analysis. BJA open 2024; 9 : 100250. Doi: 10.1016/j.bjao.2023.100250.

29. Katori H, Tsukuda M. Acute epiglottitis: analysis of factors associated with airway intervention. J Laryngol Otol 2005; 119 (12): 967–972. Doi: 10.1258/002221505775010823.

30. Pineau PM, Gautier J, Pineau A et al. Intubation decision criteria in adult epiglottitis. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 (5): 329–332. Doi: 10.1016/j.anorl.2020.12.001.

31. Chang YL, Lo SH, Wang PC et al. Adult acute epiglottitis: experiences in a Taiwanese setting. Otolaryngol Head Neck Surg 2005; 132 (5): 689–693. Doi: 10.1016/j.otohns.2005.01.011.

32. Sajeermohammed A, Mathias R, Shaikh N et al. Acute adult supraglottitis: Difficult intubation & potential airway loss. Trends in Anaesthesia and Critical Care 2023; 50 : 101256. Doi: 10.1016/j.tacc.2023.101256.

33. Shimizu Y, Mori E, Wada K et al. Airway intervention in cases of acute epiglottitis. B-ENT 2016; 12 (4): 279–284.

34. Švejdová A, Kordač P, Chrobok V. Tracheostomie u dětí –⁠ sedmileté zkušenosti z Kliniky otorinolaryngologie a chirurgie hlavy a krku ve Fakultní nemocnici Hradec Králové. Otorinolaryngol Foniatr 2020; 69 (3): 122–126.

35. Tapiovaara LK, Aro KL, Bäck LJ et al. Comparison of intubation and tracheotomy in adult patients with acute epiglottitis or supraglottitis. Eur Arch Otorhinolaryngol 2019; 276 : 3173–3177. Doi: 10.1007/s00405-019 -⁠ 05624-0.