Epiglottitis

Posted by

What is Epiglottitis?

An inflammation of the epiglottis is known as epiglottitis. It’s considered a potentially life-threatening condition1,2. The epiglottis is a leaf-like structure that is found at the superior end within the larynx in a person’s throat. This structure is located at the floor of the tongue and it mostly comprises cartilage tissue. It’s kind of a switch or valve that regulates activities of the esophagus and the larynx or voice box. It works to permit air to gain entry to the airways leading to the lungs. It also permits food and drinks to pass and move to the gastrointestinal tract (GI).

Epiglottis

Another function of the epiglottis is to offer protection to the body from things like choking caused by food or other things that would otherwise obstruct the airway.1,3 The structure prevents food or liquids from reaching the windpipe when a person is eating or drinking.

If there is an infection of epiglottis, it can swell and block the airway. This can be a serious condition that requires prompt medical attention. It should be considered a medical emergency. Epiglottitis has in the past been common in children, however, today, it has become a frequent condition among adults. The illness requires immediate diagnosis and treatment, especially in children because they tend to be vulnerable to complications associated with breathing.1,2

Causes of Epiglottitis

The commonest cause of epiglottitis is a bacterial infection specifically Haemophilus influenzae type B, which is popularly known as Hib. Bacteria may enter the body of an individual when they breathe it in. If the bacteria infect the epiglottis, they can cause epiglottitis. People can catch Hib through inhalation of the germs that are spread after an infected person sneezes, coughs, or blows their nose.

Epiglottitis

It is also likely for other bacteria strains to cause the illness including Streptococcus pneumonia and Streptococcus A, B, or C. Streptococcus A strain of bacteria is also responsible for causing other illnesses like strep throat. Being infected with Streptococcus pneumonia may cause conditions like bacterial pneumonia.1,2,4,6,7

In addition to bacterial causes, there are also other microbes that may bring about epiglottitis. For example, viruses involved in causing chickenpox and singles may also cause epiglottitis. Viruses that cause infections of the respiratory system can as well result in epiglottitis.

It is also possible for fungi to cause the condition for example, the ones that are responsible for causing yeast infection or diaper rash.

Other possible causes of epiglottitis are: 1,2,4,6,7

  • Swallowing foreign objects
  • Smoking crack cocaine
  • Inhaling chemical substances or having chemical burns
  • A burn of the throat from hot foods or steam
  • Trauma causing injury to throat for example, a gunshot, stabbing, or accidentally hitting the epiglottis during intubation
  • In rare instances, the illness may be caused by insect stings, insect bites, or allergic foods. If you get a sting from a bee when eating raw heavy, you can have the epiglottis swelling.2

Epiglottis can affect anyone, but children are at a greater risk. Children that are younger than 12 months are considered to be more vulnerable to this illness. The reason is because at this age, children are not yet done with having their Hib immunization series. In general, the illness is commonly reported in children who are at the age of 2 to 6. Also, older adults are at risk, especially those who have attained 85 years and above.

Children residing in countries that don’t provide vaccines or where vaccines are not easy to get may also be at risk. Some parents may choose not to immunize their children with Hib vaccine and this puts the kids at risk of developing epiglottitis. It is also found that males tend to suffer the illness more than females and it is not clear why there is this gender difference. People with weakened body immunity tend to be susceptible to suffering from the illness. Having diabetes puts individuals at risk too.

Symptoms of Epiglottitis

While there may be various causes of epiglottitis, the symptoms are similar, but there are some differences seen between children and adults. Kids can have epiglottitis in just a matter of hours, however, in adults, the illness develops slowly, often taking a couple of days.

In children, the epiglottitis symptoms are:1,2,4,7

  • Drooling
  • Sore throat
  • High fever accompanied by chills
  • Restlessness
  • Difficulty swallowing
  • A hoarse voice
  • Breathing through the mouth
  • Painful swallowing
  • Lessening of the symptoms after the child leans forward or sits upright
  • Cough
  • Ear pain
  • Anxiety
  • Refusing to eat

In adults, the symptoms of epiglottitis may present in the following ways: 1,2,4,7

  • Having harsh, noisy breathing – stridor
  • Fever
  • A severe sore throat
  • Difficulty breathing
  • Unable to catch breath
  • Muffled or raspy voice
  • Difficulty swallowing
  • Rapid swallow breaths
  • Trouble speaking
  • Leaning forward to allow breathing

Not treating epiglottitis could lead to blocking of airways completely and it may result in discoloration of the skin because of lack of oxygen. The skin will assume a bluish appearance. If this happens, it should be seen as a highly critical situation needing immediately medical help.

Diagnosis of Epiglottitis

If it is suspected that a patient has epiglottitis, the first thing it to ensure that sufficient oxygen is going to the lungs. A pulse oximeter may be used to give an estimate on the amount of oxygen in blood. If it is found that the oxygen saturation has dipped to extremely lower levels, a child may require help with breathing. The aim is to stabilize the condition before further tests are conducted. A doctor my order for tests and perform a physical exam.

X-ray

A neck or chest X-ray is ordered to examine the region and the epiglottis. The X-ray may show something like a thumbprint within the neck, and this is an indication that the epiglottis is enlarged.

Throat examination

A doctor uses a flexible fiber-optic tube comprising a light that looks down the throat to find out the cause for the symptoms. In the process, a local anesthetic may be applied to reduce discomforts.

Throat or blood culture

A doctor may order throat culture test whereby the epiglottis is wiped using a cotton swab. The fluid and tissue sample obtained with the cotton swab is then taken for laboratory analysis to check for Hib. Also the doctor may order that blood culture is done to find out if bacteremia may have occurred.

In bacteremia, bacteria enter the blood causing a serious bloodstream infection. Sometimes, bacteremia may accompany epiglottitis.

Other lab tests conducted to evaluate a patient for epiglottitis are blood tests to check for inflammation or infection. Arterial blood gas test that measures oxygenation of a person’s blood as well as the severity of airway obstruction may also be done. Immunological tests are conducted to look for antibodies that may point out to the specific virus or bacteria causing epiglottitis.

Proper diagnosis is needed because even with modern technology, it proves difficult to diagnose epiglottitis. In its early stages, the condition may be misdiagnosed as infectious mononucleosis, diphtheria, strep throat, or croup. It is quite easy to confuse a case of epiglottitis for croup.

Clinically, epiglottitis differs from croup in that it progressively worsens over time and there is lack of what is described as barking cough. In croup, the epiglottis is not swollen and appears red or pinkish, but in a case of epiglottitis, the epiglottis is swollen often appearing cherry red.

Treatment for Epiglottitis

When a person is suspected to have epiglottitis, immediate hospitalization should be done because the patient is in danger of having sudden or unpredictable airway closure. A secure breathing should be established. A patient may be prescribed antibiotics. The treatment approach may be as follows:

  • First, a doctor should make sure the patient is comfortable by ensuring sufficient oxygen is reaching the lungs. If no respiratory distress is detected, IV fluids may help the patient. It is also important that anxiety is prevented because it can cause acute airway blockage particular in young children.
  • If there are signs of airway blockage, laryngoscopy is required. In severe cases a doctor may have to perform a procedure known as cricothyrotomy, which involves cutting the neck and inserting a tube to help with breathing. The tube is placed into the windpipe. This option should however be looked at carefully, and only done if the patient seems to be critically ill or there is near-complete obstruction of airways.
  • IV antibiotics can help clean an infection in the epiglottis. It also helps control inflammation.

The prognosis may be good if the illness is diagnosed in advance and proper treatment offered. However, if there is inappropriate diagnosis or misdiagnosis, it can make the prognosis to be poor and there are likelihoods of the patient having prolonged handicap or even death. Epiglottitis can be prevented by ensuring that a child gets immunization against H. influenza type b (Hib).

If there is a child in a family who is aged 4 years and below and who is exposed to an individual infected with H influenza epiglottitis, it is important that all persons in the family are given preventive medications like rifampin to ensure that the illness doesn’t spread. The medication will help to eradicate the bacteria from the bodies of the infected individual, the child, and the members of the family. This helps to prevent a situation like ‘carrier state’ whereby an individual carries the bacteria in their body but they don’t actively become sick. The danger of having carriers of the bacteria is that it can still spread to infect other people.

Reference List

  1. Epiglottitis. https://www.healthline.com/health/epiglottitis
  2. https://www.emedicinehealth.com/epiglottitis/article_em.htm
  3. Epiglottis. http://www.innerbody.com/image_digeov/dige02-new2.html
  4. Epiglottitis: Symptoms and Causes. https://www.mayoclinic.org/diseases-conditions/epiglottitis/symptoms-causes/syc-20372227
  5. Epiglottitis: Diagnosis and Treatment: https://www.mayoclinic.org/diseases-conditions/epiglottitis/diagnosis-treatment/drc-20372231
  6. https://www.msdmanuals.com/home/ear,-nose,-and-throat-disorders/mouth-and-throat-disorders/epiglottitis
  7. Epiglottitis. https://www.webmd.com/a-to-z-guides/epiglottitis-infection-inflammation#1

229 comments

  1. Great post. I was checking constantly this blog and I am impressed! Very helpful information specifically the last part 🙂 I care for such info much. I was looking for this particular information for a very long time. Thank you and best of luck.

  2. Auto Like, Autoliker, Autoliker, Increase Likes, autolike, ZFN Liker, auto like, Autolike International, Status Auto Liker, Auto Liker, autoliker, Autolike, auto liker, Photo Liker, Photo Auto Liker, Status Liker, Working Auto Liker

  3. Nice post. I learn something more challenging on different blogs everyday. It will always be stimulating to read content from other writers and practice a little something from their store. I’d prefer to use some with the content on my blog whether you don’t mind. Natually I’ll give you a link on your web blog. Thanks for sharing.

  4. I think this is one of the most vital information for me.
    And i’m glad reading your article. But should remark on few general things,
    The site style is ideal, the articles is really great : D.
    Good job, cheers

  5. Hi there would you mind stating which blog platform you’re using?
    I’m looking to start my own blog soon but I’m having a hard time deciding between BlogEngine/Wordpress/B2evolution and Drupal.
    The reason I ask is because your layout seems different then most blogs and I’m
    looking for something completely unique.
    P.S Sorry for getting off-topic but I had to ask!

  6. Thank you a lot for sharing this with all people you
    really understand what you’re speaking approximately!
    Bookmarked. Please additionally visit my web site =).
    We can have a link change contract between us

  7. This is very interesting, You’re a very skilled blogger. I’ve joined your rss feed and look forward to seeking more of your fantastic post. Also, I have shared your website in my social networks!

  8. Almost all of the things you point out is astonishingly legitimate and it makes me ponder the reason why I had not looked at this in this light previously. Your piece truly did switch the light on for me as far as this specific subject goes. Nonetheless at this time there is just one position I am not necessarily too comfortable with and while I make an effort to reconcile that with the actual central theme of the issue, permit me observe what all the rest of your readers have to say.Well done.

  9. It’s the best time to make some plans for the future and it is time to be happy. I have read this post and if I could I wish to suggest you few interesting things or suggestions. Perhaps you could write next articles referring to this article. I wish to read even more things about it!

  10. Very great post. I simply stumbled upon your blog and wished to
    mention that I have truly enjoyed browsing your blog
    posts. In any case I’ll be subscribing on your feed and I hope you write once more very soon!

  11. Great blog! Do you have any tips and hints for aspiring writers?
    I’m hoping to start my own blog soon but I’m a little lost on everything.
    Would you propose starting with a free platform like WordPress
    or go for a paid option? There are so many options out there that I’m completely confused ..
    Any recommendations? Cheers!

  12. Can I just say what a relief to uncover somebody who really understands what
    they’re talking about on the net. You actually understand how to
    bring an issue to light and make it important. More people should read this and understand this side of the story.
    I was surprised you are not more popular since you surely possess
    the gift.

  13. Incredible! This blog looks exactly like my old one! It’s
    on a completely different topic but it has pretty much the same page layout and design. Wonderful choice of colors!

  14. Fantastic website you have here but I was curious about if you knew of
    any community forums that cover the same topics talked about
    here? I’d really like to be a part of group where I can get feedback
    from other knowledgeable people that share the
    same interest. If you have any suggestions, please let me know.

    Kudos!

  15. My brother suggested I may like this web site. He was once
    entirely right. This put up truly made my
    day. You can not imagine just how much time I had spent
    for this info! Thank you!

  16. Hello my loved one! I want to say that this article is awesome,
    nice written and come with almost all vital infos.
    I would like to peer more posts like this .

  17. What i do not realize is if truth be told how you are now not
    really a lot more neatly-preferred than you might be now.
    You’re so intelligent. You recognize therefore significantly
    in the case of this topic, made me in my opinion imagine it from a lot of
    varied angles. Its like men and women are not interested until it’s one thing to accomplish with Woman gaga!
    Your personal stuffs outstanding. At all times maintain it up!

  18. Hi i am kavin, its my first occasion to commenting anyplace, when i read this paragraph i thought i could also make comment due to this brilliant piece of
    writing.

  19. I do consider all the ideas you have presented for
    your post. They are very convincing and can certainly work.
    Nonetheless, the posts are very quick for beginners.
    May you please lengthen them a bit from next time?
    Thanks for the post.

  20. Awesome blog! Do you have any helpful hints for aspiring writers?
    I’m hoping to start my own site soon but I’m a little lost
    on everything. Would you recommend starting with a free platform like WordPress or go for a paid option? There are
    so many options out there that I’m completely confused ..
    Any suggestions? Many thanks!

  21. hello there and thank you for your info – I have definitely picked up something
    new from right here. I did however expertise a few technical issues using this
    web site, as I experienced to reload the web site a lot of times
    previous to I could get it to load properly. I had been wondering if
    your hosting is OK? Not that I am complaining,
    but sluggish loading instances times will very frequently affect your placement in google and can damage your high-quality score if advertising and marketing with Adwords.
    Well I am adding this RSS to my e-mail and could look out for much more
    of your respective interesting content. Make sure you update
    this again very soon.

  22. Hi there outstanding blog! Does running a blog similar to
    this take a lot of work? I have absolutely no expertise in computer programming
    however I had been hoping to start my own blog in the near future.
    Anyway, if you have any suggestions or tips for new blog owners please share.
    I know this is off subject nevertheless I just wanted to ask.

    Thanks!

  23. Very good site you have here but I was wanting to know if you
    knew of any message boards that cover the same topics talked about in this article?
    I’d really like to be a part of online community where I can get suggestions from other knowledgeable people that share the same
    interest. If you have any suggestions, please let me know.
    Bless you!

  24. When the love is strong, eachother is in the sea; when the love is weak, it is the same. Love cannot fade when it is strong, but it is difficult to thick when it is weak. Love is difficult to face, that is why it is embarrassing!

  25. Wonderful blog! Do you have any tips and hints for aspiring writers?
    I’m planning to start my own blog soon but I’m a little lost on everything.

    Would you advise starting with a free platform like WordPress or go for a paid option? There are so many options out there that I’m totally confused ..
    Any tips? Cheers!

  26. Howdy, i read your blog from time to time and
    i own a similar one and i was just wondering if you get a lot of spam comments?
    If so how do you prevent it, any plugin or anything you
    can suggest? I get so much lately it’s driving me insane so any support is very much appreciated.

  27. To be a person is to be like a flower, whether or not anyone sees it, but you must bloom. You do not bloom for others but for yourself. Don’t do other people’s rewards, just be the most dazzling self!

  28. Maybe, there are ten people who want to step you under your feet, but your strength makes them have no chance to reach out. Don’t complain about this world’s weak meat and strong food, you will gradually discover.

  29. I want to be with you, even if it is a headless and tailless farce, I will persist until the moment the world fades after you leave the stage, hold a small lamp and stand in the memory waiting for you.

  30. Hey there I am so glad I found your blog page, I really found you by error, while I was searching on Digg for something else, Nonetheless I am here now and would just like to say thanks for a incredible post and a all round entertaining blog (I also love the theme/design), I don’t have time to read it all at the moment but I have bookmarked it and also added your RSS feeds, so when I have time I will be back to read more, Please do keep up the fantastic jo.| а

  31. Time will always give you the answer, who is the one who really hurts you and who really cares about you; who is who you care about but who cares nothing about you. Some people are not worth cherishing too much, while others are worth cherishing

  32. I’ve been exploring for a little for any high quality articles or weblog posts
    on this kind of space . Exploring in Yahoo I at last stumbled upon this web site.
    Reading this info So i am glad to exhibit that I have a very excellent uncanny feeling I came upon exactly what I
    needed. I so much indisputably will make sure to do not forget
    this web site and provides it a glance regularly.

  33. I just want to tell you that I am just very new to weblog and certainly enjoyed your blog. Most likely I’m likely to bookmark your blog . You surely have terrific well written articles. Bless you for sharing with us your website page.

  34. Ephedra is definitely the the greatest fat loss dietary supplement available in the market. There isn’t a weight loss pill, that operates superior to Ephedrine. If you wish to obtain Ephedra, kindly visit the Buy Ephedra web-site.

  35. Hello! I know this is somewhat off topic but I was wondering which blog platform are you using for this website? I’m getting tired of WordPress because I’ve had problems with hackers and I’m looking at options for another platform. I would be fantastic if you could point me in the direction of a good platform.| а

  36. Hi I am so glad I found your blog page, I really found you by mistake, while I was browsing on Google for something else, Anyways I am here now and would just like to say thanks a lot for a fantastic post and a all round enjoyable blog (I also love the theme/design), I don’t have time to read through it all at the minute but I have book-marked it and also added in your RSS feeds, so when I have time I will be back to read a lot more, Please do keep up the superb jo.| а

  37. Its like you read my mind! You seem to know so much about this, like you wrote the book in it or something. I think that you could do with a few pics to drive the message home a bit, but instead of that, this is wonderful blog. An excellent read. I will definitely be back.| а

  38. I discovered your blog site website on the internet and check a number of your early posts. Preserve in the very good operate. I simply additional increase Feed to my MSN News Reader. Looking for toward reading a lot more by you at a later date!…

  39. Hello I am so delighted I located your site, I really located you by mistake, while I was looking on yahoo for something else, Anyways I am here now and could just like to say cheers for a tremendous post and a all round entertaining website. Please do keep up the great work.

  40. With havin so much written content do you ever run into any problems of plagorism or copyright violation? My site has a lot of completely unique content I’ve either authored myself or outsourced but it seems a lot of it is popping it up all over the internet without my permission. Do you know any methods to help reduce content from being ripped off? I’d genuinely appreciate it.| а

  41. First off I want to say wonderful blog! I had a quick question that I’d like to ask if you don’t mind. I was curious to know how you center yourself and clear your thoughts prior to writing. I’ve had trouble clearing my thoughts in getting my ideas out there. I truly do enjoy writing however it just seems like the first 10 to 15 minutes are lost just trying to figure out how to begin. Any ideas or tips? Thank you!| а

  42. You actually make it seem really easy with your presentation however I find this topic to be actually one thing which I believe I would never understand. It sort of feels too complex and extremely huge for me. I’m having a look forward in your next put up, I’ll attempt to get the grasp of it!| а

  43. Hmm it appears like your site ate my first comment (it was extremely long) so I guess I’ll just sum it up what I wrote and say, I’m thoroughly enjoying your blog. I as well am an aspiring blog blogger but I’m still new to the whole thing. Do you have any points for novice blog writers? I’d certainly appreciate it.| а

  44. It is the best time to make some plans for the future and it’s time to be happy. I have read this post and if I could I want to suggest you some interesting things or suggestions. Maybe you can write next articles referring to this article. I desire to read more things about it!

  45. I’m very happy to uncover this website. I want to to thank you for ones time due to this fantastic read!! I definitely loved every part of it and i also have you book marked to see new information in your web site.

  46. I do not know if it’s just me or if everybody else experiencing issues with your site. It appears like some of the text within your posts are running off the screen. Can somebody else please comment and let me know if this is happening to them too? This might be a issue with my web browser because I’ve had this happen previously. Appreciate it| а

  47. Hey! Quick question that’s completely off topic. Do you know how to make your site mobile friendly? My web site looks weird when viewing from my apple iphone. I’m trying to find a template or plugin that might be able to correct this issue. If you have any recommendations, please share. Cheers!| а

  48. Hi there, You have done an incredible job. I’ll
    definitely digg it and personally suggest to my friends.
    I’m sure they will be benefited from this web site.

  49. I merely wish to inform you that I am new to blogging and extremely cherished your review. Probably I am going to store your blog post . You undoubtedly have excellent article information. Delight In it for share-out with us your blog document

  50. Hello there! I know this is kinda off topic nevertheless I’d figured I’d ask. Would you be interested in trading links or maybe guest writing a blog post or vice-versa? My site goes over a lot of the same subjects as yours and I think we could greatly benefit from each other. If you’re interested feel free to send me an e-mail. I look forward to hearing from you! Wonderful blog by the way!| а

  51. Hey would you mind sharing which blog platform you’re working with? I’m looking to start my own blog in the near future but I’m having a tough time making a decision between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design seems different then most blogs and I’m looking for something unique. P.S Apologies for getting off-topic but I had to ask!| а

  52. I don’t know whether it’s just me or if perhaps everyone else experiencing issues with your blog. It seems like some of the written text within your posts are running off the screen. Can somebody else please provide feedback and let me know if this is happening to them too? This could be a problem with my internet browser because I’ve had this happen before. Cheers| а

  53. I simply desire to tell you that I am new to blogging and pretty much adored your work. Very possible I am prone to remember your blog post . You indeed have outstanding article materials. Like it for giving out with us the best web information

  54. It certainly is almost extremely difficult to find well-informed people on this area, unfortunately you appear like you fully grasp whatever you’re raving about! Appreciation

  55. Considering the fact that fundamentals will be in spot to push gold to
    new highs, that include a persistantly expanding monetary base, fears about future inflation and uncertainty concerning the European debt crisis, one could think the run would continue.

    Avoid the Auto Loan Scams – To avoid situations for example these,
    prospective buyers would be wise to get pre-approved for an auto loan. If you are
    having short-run financial disaster and therefore
    are searching an economic minus the demand of collateral then a unsecured
    loans suit you the most.

  56. Good day! I just would like to give you a huge thumbs up
    for your great information you have right here on this post.
    I’ll be returning to your blog for more soon.

  57. Considering the truth that fundamentals come in destination to push gold to new highs, such as a persistantly expanding monetary base, fears about future inflation and uncertainty concerning the European debt crisis, one could think the run would continue.
    Try getting quotes and continue looking around online which
    would offer you a advantage on negotiating your loan. In fact, over
    a million satisfied customers are actually served, including those that have less-than perfect credit scores,
    have been approved within 5 minutes and gained usage of no
    more than $700 these business day.

  58. Considering the fact that fundamentals have been in location to push gold to new highs,
    that include a constantly expanding monetary base, fears about future
    inflation and uncertainty regarding the European debt crisis, you
    might think the run would continue. Note that only original equipment dealers can legally call a motor vehicle “certified used. For your convenience this scheme is availing you with different types of it among that you can apply for the most suitable.

  59. Before you move forward to get one of these
    brilliant loans, you should make sure that you could repay the funds
    in addition to the interest rate upon the agreed time, that’s
    usually two weeks. Some people also call these “cash advances”, although two could be very different.
    Sure, the issue is gone for now but you cannot carry on using the
    same old tricks again and again again.

  60. This program has been used by thousands of people with low credit score
    all over the world to get unsecured loans instantly. The borrower must only
    be careful while giving in information about his confidential details like his bank-account
    number, phone number, e – mail address, ID proof, employment letter, along with your residential address.
    Getting car loans after bankruptcy doesn’t have to be an unpleasant and
    painful situation.

  61. Online lenders, however, squeeze money directly into your bank-account.
    Cash advance payday loans might be highly useful tools to
    get when you need them, however they can also be highly dangerous
    if misused, thus handle these loans along
    with the lenders offering them carefully to prevent falling in to the trap of monetary
    destruction. The economic crunch has felt across the world and everybody is trying to work with the opportunity they have to finance themselves.

  62. Online lenders, however, position the money directly into your banking account.
    The borrower must just be careful while giving in details about his confidential details like his bank account number, contact number, email address, ID proof, employment letter, plus
    your residential address. The economic crunch
    is being felt around the world and everyone is looking to work with the opportunity they must finance themselves.

  63. Keep in mind that personal business loans have serious upside but
    also ample downside as well. You will need to fill out the
    application form while using necessary details.
    If any with the above occur, you might be left without the vital
    tools you need to treat your patients on the best of your ability.

  64. I was suggested this web site by my cousin. I am not sure
    whether this post is written by him as no one else know such detailed about my problem.
    You are wonderful! Thanks!

  65. Write more, thats all I have to say. Literally, it seems as though you relied on the video to make
    your point. You clearly know what youre talking about, why waste your intelligence on just posting
    videos to your blog when you could be giving us something
    informative to read?

Leave a Reply to https://profwebdesign.blogspot.com/ Cancel reply

Your email address will not be published.