Epiglottitis (Supraglottitis)
Definition
Epiglottitis, often described as supraglottitis when adjacent supraglottic tissues are involved, is an acute inflammatory swelling of the epiglottis and surrounding structures. The major clinical risk is rapid progression to partial or complete upper‑airway obstruction - a time‑critical emergency.
Pathophysiology
Inflammation produces oedema of the epiglottis, aryepiglottic folds and supraglottic soft tissues. The supraglottic airway is relatively fixed and small in children, so modest swelling may cause critical narrowing. Obstruction can progress rapidly, particularly in young children.
Epidemiology
- Children: classically between 2-6 years; routine Haemophilus influenzae type b (Hib) vaccination has greatly reduced Hib‑related disease.
- Adults: most commonly in the 40s-50s; adults are more likely to have comorbidities and atypical or polymicrobial infections.
- Microbiology: Streptococcus species are now common causes in the UK, but Hib, Staphylococcus aureus, Moraxella, Pseudomonas and others remain possible.
Aetiology
- Bacterial: Streptococcus spp., Staphylococcus aureus, Haemophilus influenzae type b (unvaccinated or rare vaccine failures), Moraxella catarrhalis, Pseudomonas spp., Mycobacterium tuberculosis.
- Viral: e.g. herpes simplex virus.
- Fungal: Candida spp. in immunosuppressed patients.
- Non‑infectious: thermal or caustic injury, direct trauma or instrumentation, chemotherapy‑related mucositis.