Epiglottitis: Going, going, but not gone yet

Authors


Dr Nicholas Wood, National Centre for Immunisation Research and Surveillance, Westmead, NSW 2145, Australia. Fax: +612 9845 3421; email: nicholw3@chw.edu.au

Acute epiglottitis is a potentially life-threatening infection because it may cause sudden upper airways obstruction. Prior to the introduction of Haemophilus influenzae type b (Hib) vaccination in 1993, the estimated annual incidence of epiglottitis in Australia was 20–30 episodes per 100 000 population <5 years old.1 The Hib immunisation programme has been a great success, with national notifications decreasing 97% from 2.9 per 100 000 in 1992 to 0.09 per 100 000 in 2007. The fall was in both the immunised and non-immunised population, due to herd immunity. The number of confirmed Hib epiglottitis cases has continued to decline with ongoing immunisation, with a 76% decrease in children <15 years of age from 39 between 1995 and 2000 to only 12, or about 2 per year, between 2000 and 2005.2

After routine immunisation, epiglottitis quickly became a diagnostic and management challenge for clinicians.3 It is important that appropriate diagnostic tests are performed in all cases, because clinically diagnosed epiglottitis cannot be assumed to be due to Hib. A review comparing all recorded epiglottitis hospitalisations in Sydney between 1990 and 1992 (pre-immunisation) with those between 1998 and 2000 (5 years post-immunisation) found that Staphylococcus aureus and group A streptococci were identified from post-intubation epiglottic swabs in both eras. Although Hib was isolated from blood cultures in 62 cases in the first 3-year period, the only blood culture isolate (from an adult) in the post-immunisation era was Streptococcus pneumoniae.4 Blood cultures and epiglottis swabs taken at intubation should be routine in managing epiglottitis.

The poem is an important reminder in the current era. Clinicians who have had little or no experience in managing acute epiglottitis in children need to remain aware of its presentation and management, because cases still occur.5 Prompt recognition and treatment can be life saving.

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