Adult supraglottitis: a potential airway emergency that can present in primary care.

INTRODUCTION Adult supraglottitis is a serious and potentially life-threatening condition, characterised by inflammation of the supraglottic structures of the larynx, namely the arytenoids, the false vocal cords, the laryngeal ventricles, the aryepiglottic folds and the epiglottis. This condition presents a diagnostic challenge owing to the nonspecific nature of the clinical presentation. Patients with supraglottitis can rapidly develop airway compromise due to swelling of the supraglottic structures, potentially leading to respiratory arrest. In infective cases of supraglottitis, the infection can spread to adjacent structures, resulting in parapharyngeal abscess, epiglottic abscess or Lemierre Syndrome (thrombosis of the internal jugular vein). Although the incidence of supraglottitis has decreased in children since the introduction of the Haemophilus influenza type B (HiB) vaccine, most epidemiological studies suggest the incidence in adults has stayed the same1 or increased,2 with figures for the annual incidence varying from 1.1 to 4.7 per 100 000.2,3 When an infectious agent is isolated, the most commonly described pathogen is Streptococcus pneumoniae,3 although other bacteria including Staphylococcus aureus4 and Neisseria meningitides 5 have been implicated. Less commonly seen are non-bacterial causes, which include viruses, trauma, thermal injury, irritant chemicals, recreational drugs, chemotherapy, and radiotherapy.