What is the most common cause of epiglottitis?

From the Guidelines

The most common cause of epiglottitis is infection with Haemophilus influenzae type b (Hib), although its incidence has decreased in developed countries due to widespread vaccination, and other bacterial causes such as Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus are now more prominent. According to the provided evidence, the microbiology of epiglottitis is complex and can involve various bacterial pathogens 1. The condition typically presents with severe sore throat, difficulty swallowing, drooling, fever, and respiratory distress.

Key Considerations

• The diagnosis of epiglottitis depends on the collection of an aspirate or biopsy of inflammatory material from affected tissues and tissue spaces, while avoiding contamination with mucosal flora 1.
• Blood cultures are the preferred sample for the diagnosis of epiglottitis, and if swabbing is attempted, it should be in a setting with available appropriate emergency response 1.
• Treatment typically involves securing the airway, administering intravenous antibiotics, and corticosteroids to reduce inflammation.

Bacterial Causes

• Haemophilus influenzae type b (Hib) was historically the predominant cause of epiglottitis, but its incidence has decreased in developed countries due to widespread vaccination 1.
• Other bacterial causes now include Streptococcus pneumoniae, Streptococcus pyogenes (group A strep), and Staphylococcus aureus 1.
• In adults, non-infectious causes like thermal injuries from hot liquids or caustic substances, trauma, or allergic reactions may also trigger epiglottitis.

Management

• Epiglottitis is a medical emergency requiring prompt recognition and management to prevent airway obstruction.
• Treatment typically involves securing the airway, administering intravenous antibiotics (such as ceftriaxone 1-2g IV daily or ampicillin-sulbactam 3g IV every 6 hours), and corticosteroids to reduce inflammation.

From the Research

Causes of Epiglottitis

• The most common cause of epiglottitis is bacterial infection, with Streptococcus pneumoniae being a major contributor 2, 3.
• Historically, Haemophilus influenzae type b was a significant cause of epiglottitis, especially in children, but its incidence has decreased with the introduction of vaccination programs 2, 4.
• Other studies have also highlighted the importance of Streptococcus pneumoniae as a causative agent in adult epiglottitis, suggesting that vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) could be effective in preventing the infection 2.

Bacterial Epidemiology

• The incidence of Streptococcus pneumoniae epiglottitis in adults has been found to be increasing, with a study showing an incidence of 0.28 cases/100,000/year 2.
• The serotype distribution of Streptococcus pneumoniae in epiglottitis cases has been found to be represented in the 23-valent pneumococcal polysaccharide vaccine (PPV23), indicating that the infection is preventable by vaccination 2.

Clinical Presentation and Diagnosis

• Epiglottitis can present with symptoms such as inflammation and progressive airway obstruction, and direct visualization by laryngoscopy is the gold standard for diagnosis 5, 6.
• Lateral neck X-rays can also be useful in diagnosing epiglottitis, but with less sensitivity than direct visualization 5.