INTRODUCTION – AGENTS

Patients with supraglottitis may present to the acute care setting with complaints of a sore throat and difficulty breathing. These symptoms may reflect a self-limited upper respiratory infection (URI) or, infrequently, an impending airway emergency.

Supraglottitis describes inflammation of the supraglottic structures, which include the epiglottis, the false vocal cords and arytenoids, and the aryepiglottic folds. In the past these infections were all called epiglottitis, but supraglottitis is a more anatomically accurate description as the surrounding supraglottic structures are usually involved. The vallecula and tongue base, technically part of the oropharynx, may also be affected.

Haemophilus influenzae was previously the primary organism responsible for epiglottitis/supraglottitis. With the advent of the H. influenzae type B (HIB) vaccine and its widespread use, the overall incidence of supraglottitis and H. influenza as a causative organism has decreased significantly. Other causative etiologies include Streptococcus pneumoniae, Streptococcus pyogenes Staphylococcus species, and other Haemophilus species, such as Haemophilus parainfluenzae. Less commonly involved are bacteria such as Klebsiella or Pseudomonas, viruses, or Candida.

EPIDEMIOLOGY

In the past, young children made up the majority of cases of epiglottitis (see Chapter 49, Pediatric Respiratory Infections). With widespread HIB vaccination of the pediatric population, however, the disease is now more common in adults than children in the United States.