Etiology of acute infectious epiglottitis in adults: septic vs. local infection

Adult patients with acute epiglottitis hospitalized between 1975 and 1988 were retrospectively analysed. 79 of 138 patients had a valid diagnosis and had delivered at least one blood culture and were considered eligible for further evaluation. Cultures from the upper airways, including epiglottis, were available in 43 of the patients as a consequence of prospective measures. 27% of the patients had bacteremia, which may however be an overestimation. Haemophilus influenzae was the predominating finding, but Streptococcus pneumoniae was isolated from 3 severely ill patients, indicating the existence of pneumococcal epiglottitis at a rate of less than 5%. From the non-bacteremic patients with a localized disease, either H. influenzae or beta-hemolytic streptococci were isolated from the epiglottis in one third of the cases. The distribution of pathogens in upper airways indicates that beta-hemolytic streptococci may have an etiological role in acute infectious epiglottitis. Except for H. influenzae, species with the potential ability of beta-lactamase production have no significance in the disease.