Épiglottites : clinique, pathogénie, conduite à tenir

Abstract

In the most frequent presentation, infectious epiglottitis is a cellulitis of hypopharynx which occurs in septicemic conditions, usually due to Haemophilus influenzae. The development of antihaemophilus vaccination has resulted in its disappearance from countries using widely the vaccine. However this disease has not totally been eradicated, since other bacterial species can be involved, such as Group A streptococci or meningococci. The incidence of epiglottitis is increasing in adults and, in immunodepressed patients, various organisms can be responsible for this disease : Enterobacteriaceae, Candida albicans, rare cases with viruses (herpes, VZV). Non infectious epiglottitis may occur by means of burn or caustic agent. Typical presentation of epiglottitis, with quick onset, includes dysphagia and rapidly increasing obstructive dyspnea, resulting in potentially complete obstruction of the upper respiratory tract. Interruption of cardiac/respiratory functions can occur at any time, stimulated by inappropriate actions (forced decubitus position, examination by using a tongue blade, psychological agression). Suspected epiglottitis requires immediate hospitalisation in Intensive Care Unit. Intubation is generally recommended despite vital risk to some extent. Intra-venous antibiotic therapy must be started immediately, using 3d generation cephalosporin, and in immunodepressed patient, an enlarged antibiotic spectrum. In uncomplicated cases, the duration of intubation must be limited to few hours and antibiotic therapy to several days.