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[Acute epiglottitis caused by Haemophilus influenzae type b in children: presentation of 21 cases]
M del Carmen Otero1, N Sanchís, V Modesto
1Sección de Enfermedades Infecciosas Pediátricas, Hospital Infantil La Fe, Valencia.
Insights
Despite available vaccination, Haemophilus influenzae type b (Hib) epiglottitis remains a serious pediatric infection. Early diagnosis and treatment are crucial for managing this potentially fatal condition in children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Haemophilus influenzae type b (Hib) epiglottitis is a severe childhood infection.
- Vaccination has reduced incidence, but awareness is still critical.
Purpose of the Study:
- To review the epidemiological, clinical, and therapeutic features of Hib epiglottitis in children.
- To highlight the importance of early diagnosis and treatment despite vaccination.
Main Methods:
- Retrospective review of 21 children diagnosed with epiglottitis and confirmed Hib infection.
- Data collected from clinical histories between 1971 and 1996.
Main Results:
- Incidence of 4/100,000 children under 5; 52.4% diagnosed after >12 hours.
- Common symptoms: respiratory distress (100%), fever (85.7%). 90.5% required intubation.
- 57.1% of Hib strains were ampicillin-resistant due to beta-lactamase production. Mortality rate was 4.8%.
Conclusions:
- Hib epiglottitis is a significant pediatric concern requiring prompt medical attention.
- Pediatricians must maintain high suspicion for early diagnosis and management.
Background:
The aim of this paper is to review the epidemiological, clinical and therapeutical characteristics of Haemophilus influenzae type b (Hib) epiglottitis in children at a time when an efficient and safe vaccination is available.
Methods:
The clinical histories of 21 children admitted to Children's Hospital La Fe (1971-1996) with a clinical diagnosis of epiglottitis and isolation of the microorganism in blood cultures (20 cases) and surface culture of the epiglotis (one case) are reviewed.
Results:
The annual average was 4/100,000 children under 5 years of age. Evolution prior to diagnosis was > 12 hours in 52.4% of the cases. More males were affected (52.4% vs 47.6%). All the children except one (95.2%) were under 5 years of age; 81% were under 3 years of age and 1 child was 6 years and 8 months old. Respiratory distress (100%) and fever > or = 38 degrees C (85.7%) were the most common clinical manifestations. General health was affected in 71.4% of the cases and 66.7% had leucocytosis on admission. The clinical diagnosis was confirmed by direct visualization of the epiglotis in 76.1% of the cases. Hib was isolated in blood culture in 20 cases (95.2%). The strains produced beta-lactamases and were ampicillin-resistant in 57.1%. 19 children (90.5%) required endotracheal intubation. Initial empiric antibiotic therapy was third generation cephalosporins (cefotaxime or ceftriaxone) alone or combined with ampicillin. One child died (4.8%).
Conclusions:
Pediatricians must still be aware of this serious infection in order to diagnosis and treat it as early as possible.