aguda en adultos
1: Postgrad Med 2002 Jul;112(1):81-2, 85-6 [Texto
Identifying acute epiglottitis in adults. High
degree of awareness, close monitoring are key.
Sack JL, Brock CD.
Department of Family Medicine, Medical
University of South Carolina College of Medicine, 9298 Medical Plaza Dr,
Charleston, SC 29406, USA. firstname.lastname@example.org
Epiglottitis can be a rapidly fatal condition in
adults. Important clues that should raise clinical suspicion include the
tripod sign, fever, stridor, sore throat, odynophagia, shortness of breath,
and drooling. These features must be differentiated from those associated
with common viral infections. The most helpful diagnostic studies are
radiography of the neck and direct laryngoscopy. The patient's airway
should be monitored during evaluation to avoid obstruction. Successful
management requires teamwork between the primary care physician and
personnel skilled in intubation as well as timely consultation with an
otolaryngologist. Laryngoscopy and intubation always should be performed
by the most skilled personnel because repeated attempts may increase
periepiglottal swelling and the risk of airway obstruction. Racemic
epinephrine should be avoided because of the rebound effect. Awareness of
the possibility of epiglottitis in adults and close monitoring of the
airway are the keys to management of this potentially life-threatening
2: Eur J Emerg Med 2002 Jun;9(2):167-9
Adult acute epiglottitis and foreign body in the
throat - chicken or egg?
Accident and Emergency Department, North
District Hospital, 9 Po Kin Road, Sheung Shui, New Territories, Hong Kong
A 53 year old man presented with the chief
complaint of having a fish bone stuck in the throat for about 1 h. There
was no dysphagia or respiratory symptoms. Plain lateral neck X-ray, direct
laryngoscopy and oesophagogastroduodenoscopy showed a grossly swollen
epiglottis with narrowing of the laryngeal lumen. No foreign body was
found. His condition improved rapidly with intravenous antibiotic therapy.
As acute epiglottitis may be a sudden life-threatening condition, a high
index of suspicion should be maintained for patients who present with
alleged foreign bodies in the throat.
3: Ann Allergy Asthma Immunol
Recurrent acute epiglottitis in adults:
defective antibody response.
Gagnon R, Bedard PM, Cote L, Lavoie A, Hebert J.
Allergy and Immunology Department, Centre
Hospitalier Universite Laval, Sainte-Foy, Quebec, Canada.
BACKGROUND: Recurrent acute epiglottitis is
uncommon in adults. In the medical literature, very little is known about
the immune status of this population. OBJECTIVE: To evaluate the immune
system of a group of four adult patients with recurrent acute epiglottitis,
in what represents the largest series ever reported. METHODS: The clinical
course of these episodes was carefully evaluated and a basic immune
deficiency work-up was carried out for each patient. RESULTS: All four
patients displayed clinical and laboratory evidence of impaired humoral
immunity. One patient was splenectomized. Another patient had a below
normal immunoglobulin G level. At the time of their first evaluation, none
of our patients had specific antibodies against Haemophilus influenzae and
one had a subnormal Streptococcus pneumoniae immunoglobulin G level for a
majority of serotypes. After specific vaccination, two patients had
persistent abnormalities in their response to one or more polysaccharides
or conjugate-polysaccharide antigens. In the other two, the transient
abnormalities were corrected by immunization. CONCLUSIONS: When recurrent
acute epiglottitis occurs in adults, it is important to investigate the
immune system because a quantitative or a specific antibody deficiency
could be found. It also follows that these patients will be successfully
treated either by immunization or antibody replacement.
4: J Laryngol Otol 2001 Jan;115(1):31-4
Acute epiglottitis: a review of 80 patients.
Nakamura H, Tanaka H, Matsuda A, Fukushima E,
Department of Otolaryngology-Head and Neck
Surgery, School of Medicine, Kyorin University, Tokyo, Japan.
We reviewed 80 patients admitted to our hospital
who were diagnosed with acute epiglottitis between January 1995 and March
1999, and their clinical features, evolution and treatments were analysed.
No sexual predominance was found, and there was no patient younger than 16
years of age. The patient fatality rate was 1.3 per cent, and the
hospitalization period was markedly longer than those of other reports.
5: An Otorrinolaringol Ibero Am
Acute epiglottitis in the adult. Retrospective
study of 14 cases
[Article in Spanish]
Damborenea Tajada J, De Miguel Garcia F, Naya
Galvez MJ, Campos del Alamo MA, Martinez Berganza R, Marin Garrido C,
Ortiz Garcia A.
Servicio de O.R.L., Hospital Miguel Servet de
Acute epiglottitis instead of been a well
recognised disease in children, is a rare condition in adult patients.
Failure to diagnose epiglottitis early, in adults, undoubtedly contributes
to its continuing mortality. We report our experience with acute
epiglottitis in grown-up people with a retrospective series of 14 patients
seen in our Department from 1993 to 1997. We comment about clinical
features and therapeutic management of these patients.
6: Hosp Pract (Off Ed)
1998 Dec 15;33(12):117
Case in point. Acute epiglottitis with
Varadarajulu S, Israel R.
Department of Internal Medicine, St. Mary's
Hospital, Rochester, N.Y., USA.
7: Am J Emerg Med 1996 Jul;14(4):421-4
Epiglottitis in adults.
Veterans Affairs Medical Center, Seattle, WA
Acute epiglottitis has become a disease of
adults, probably as a result of immunization of children against
Haemophilus influenzae. This article is a review of the literature on
epiglottitis, including signs and symptoms, investigation, differential
diagnosis, and treatment in the emergency department. The microbiology is
discussed and the importance of prophylaxis in exposed persons is stressed.
8: Scand J Infect Dis 1996;28(3):261-4
Incidence, aetiology, and prognosis of acute
epiglottitis in children and adults in Sweden.
Berg S, Trollfors B, Nylen O, Hugosson S,
Prellner K, Carenfelt C.
Department of Paediatrics, Molndal Hospital,
A retrospective study of the incidence,
aetiology and case fatality rate of acute epiglottitis in children and
adults was performed. The study covered the whole of Sweden (population
8.4 million) during the years 1987-89, before general vaccination against
Haemophilus influenzae (Hi) type b was started. Patients were included if
it was documented that they fulfilled all 3 of the following criteria: (a)
red and swollen epiglottis visualized by indirect laryngoscopy, (b)
inspiratory stridor or difficulties in swallowing, and (c) a temperature
> or = 38 degrees C. A total of 306 children and adolescents (0-19
years) and 502 adults (> or = 20 years) were found. The age-specific
incidence was highest in children aged 0-4 years, (14.7/100,000 per year).
The total incidence was 3.2/100,000 per year. In the age group 0-19 years,
blood cultures had been obtained from 195 (64%) and Hi was isolated from
154 (79%). In adults (> or = 20 years), 114 of 298 blood cultures
yielded Hi, while pneumococci were isolated from 5 and group A
streptococci from 3 patients. A total of 220 children (72%) and 114 adults
(23%) needed an artificial airway. Five children and 12 adults died. In
conclusion, the incidence of acute epiglottis in Sweden is very high.
Compared to a previous country-wide study covering the years 1981-83 that
used the same methods for case finding and case definition, the incidence
in children had decreased while the incidence in adults had increased.