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Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era.
ANZ J Surg. 2018 11; 88(11):1135-1140.AJ

Abstract

BACKGROUND

This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia.

METHODS

Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed.

RESULTS

Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury.

CONCLUSION

Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.

Authors+Show Affiliations

Department of Ear Nose and Throat/Head and Neck Surgery, Austin Health, Melbourne, Victoria, Australia.Department of Intensive Care, Austin Health, Melbourne, Victoria, Australia.Infectious Diseases Department, Monash Health, Melbourne, Victoria, Australia.Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.Department of Otolaryngology, Head and Neck and Skull Base Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.Ear Nose and Throat Unit, Monash Health, Melbourne, Victoria, Australia.Department of Ear Nose and Throat/Head and Neck Surgery, Austin Health, Melbourne, Victoria, Australia.Department of Ear Nose and Throat/Head and Neck Surgery, Austin Health, Melbourne, Victoria, Australia. Department of Otolaryngology, Royal Children's Hospital, Melbourne, Victoria, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30207030

Citation

Baird, Samantha M., et al. "Review of Epiglottitis in the Post Haemophilus Influenzae Type-b Vaccine Era." ANZ Journal of Surgery, vol. 88, no. 11, 2018, pp. 1135-1140.
Baird SM, Marsh PA, Padiglione A, et al. Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. ANZ J Surg. 2018;88(11):1135-1140.
Baird, S. M., Marsh, P. A., Padiglione, A., Trubiano, J., Lyons, B., Hays, A., Campbell, M. C., & Phillips, D. (2018). Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. ANZ Journal of Surgery, 88(11), 1135-1140. https://doi.org/10.1111/ans.14787
Baird SM, et al. Review of Epiglottitis in the Post Haemophilus Influenzae Type-b Vaccine Era. ANZ J Surg. 2018;88(11):1135-1140. PubMed PMID: 30207030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era. AU - Baird,Samantha M, AU - Marsh,Philip A, AU - Padiglione,Alex, AU - Trubiano,Jason, AU - Lyons,Bernard, AU - Hays,Andrew, AU - Campbell,Matthew C, AU - Phillips,Damien, Y1 - 2018/09/11/ PY - 2018/04/18/received PY - 2018/06/14/revised PY - 2018/07/02/accepted PY - 2018/9/13/pubmed PY - 2019/10/15/medline PY - 2018/9/13/entrez KW - Haemophilus influenzae type-b KW - airway management KW - epiglottitis KW - intubation SP - 1135 EP - 1140 JF - ANZ journal of surgery JO - ANZ J Surg VL - 88 IS - 11 N2 - BACKGROUND: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. METHODS: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. RESULTS: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. CONCLUSION: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection. SN - 1445-2197 UR - https://www.unboundmedicine.com/medline/citation/30207030/Review_of_epiglottitis_in_the_post_Haemophilus_influenzae_type_b_vaccine_era_ L2 - https://doi.org/10.1111/ans.14787 DB - PRIME DP - Unbound Medicine ER -