Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends.

OBJECTIVE

To describe the epidemiology, natural history, and treatment of epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era.

METHODS

Ten-year retrospective study.

METHODS

Tertiary-care children's hospital.

METHODS

Nineteen patients with a discharge diagnosis of epiglottitis.

METHODS

As indicated by the presentation of the patient, including direct laryngoscopy, intubation, intravenous antibiotics, and steroids.

METHODS

Presentation, management, and microbiology.

RESULTS

Presenting symptoms included fever, drooling, and hot potato voice. Patients' ages ranged from 15.8 months to 17.5 (mean 8.9) years. From 1992 to 1997, the mean age was 5.8 years; from 1998 to 2002, the mean age was 11.6 years. Sixty-eight percent of patients were transferred from an outside hospital. A lateral neck radiograph was recorded in 84% of patients. Mean leukocyte count was 16600. Direct laryngoscopy with intubation was performed in 79%; intubation was for an average of 3.5 days. H. influenzae was cultured in six patients, five of which had up-to-date immunizations. The most commonly administered antibiotics were ampicillin/sulbactam and ceftriaxone. Steroids were administered to 63% of patients. Complications included deep neck space infection (2), seizure (1), recurrent illness (1), and vocal granuloma (1). There were no deaths.

CONCLUSIONS

The demographics, causative organisms, and natural history of epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with epiglottitis should be aware of current trends.