Haemophilus influenzae type b epiglottitis

doi:10.1136/bmj.326.7383.284/a

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Occasional cases will present

Carline Lee (carline@doctors.org.uk), specialist registrar,
Andrew Coatsworth, consultant

Otorhinolaryngology Department, York District Hospital, York YO3 7HE
Newcastle General Hospital, Newcastle upon Tyne NE4 6BE
Oxford Vaccine Group, University Department Paediatrics, John Radcliffe Hospital, Oxford OX3 9DU
Paediatric Infectious Disease Unit, St George's Hospital, London SW17 0QT
Immunisation Division, Public Health Laboratory Service Communicable Disease Surveillance Centre, London NW9 5EQ
Public Health Laboratory Service Haemophilus Reference Unit, John Radcliffe Hospital

EDITOR—Tanner et al describe Haemophilus influenzae type b as a cause of acute upper airways obstruction in children.1 Such epiglottitis has indeed become much less common since the introduction of the Hib vaccine, and therefore doctors are not as experienced in managing this life threatening condition now as they were previously. The vaccine is not 100% effective; so occasional cases will present, and clinicians must be aware of the dangers and how to avoid them.

In the cases quoted, two of the three patients had been sent for a lateral neck x ray film before the airway was secured. This is contraindicated in patients suspected of having epiglottitis because at any time the patient may lose their airway, and a radiology department is not a safe environment to manage this problem.

Doctors also should not attempt to cannulate …