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Clinical Review Lesson of the week

Haemophilus influenzae type b epiglottitis as a cause of acute upper airways obstruction in children

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1099
  1. K Tanner, senior house officer,
  2. G Fitzsimmons, clinical fellow in paediatric intensive care,
  3. E D Carrol, specialist registrar,
  4. T J Flood, consultant,
  5. J E Clark, consultant (
  1. Department of Paediatric Infectious Diseases and Immunology, Newcastle upon Tyne NE4 6BE
  1. Correspondence to: J Clark
  • Accepted 12 February 2002

Haemophilus 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 reports

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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