Lesson of the week: Haemophilus influenzae type b epiglottitis as a cause of acute upper airways obstruction in children
2002; BMJ; Volume: 325; Issue: 7372 Linguagem: Inglês
10.1136/bmj.325.7372.1099
ISSN0959-8138
Autores Tópico(s)Tracheal and airway disorders
ResumoHaemophilus influenzae type b epiglottitis still occurs despite immunisation, and requires emergency intubation In the United Kingdom, infection with Haemophilus influenzae type b has considerably declined since the introduction of the conjugated H influenza type b vaccine in 1992, although isolated vaccine failures do occur. In countries without routine immunisation against the disease, it continues to be a major cause of morbidity and mortality. We report on three children who presented over a three month period with epiglottitis due to H influenzae type b infection. Each child had been fully immunised. Case 1 —A 4 year old boy presented to the emergency department with a 12 hour history of fever and drowsiness, and later drooling and soft stridor. Three days previously he had visited his doctor for red inflamed ears. No antibiotics were prescribed. He had a history of glue ear and campylobacter gastroenteritis. On examination he was feverish (39.3°C) and had stridor and tachycardia. An x ray film of the neck showed swelling of the epiglottis; subsequent difficult intubation in theatre revealed a large cherry red epiglottis. He remained intubated for 36 hours and required a 20 ml/kg bolus of fluid. Blood cultures and a throat swab grew H influenzae type b. Intravenous cefotaxime was continued for 10 days, and he made an uneventful recovery. The table shows the results of blood tests performed during the acute and convalescent stages of the …
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