[Acute epiglottitis caused by Haemophilus influenzae type b in children: presentation of 21 cases].
BACKGROUND
The aim of this paper is to review the epidemiological, clinical and therapeutical characteristics of Haemophilus influenzae type b (Hib) epiglottitis in children at a time when an efficient and safe vaccination is available.


METHODS
The clinical histories of 21 children admitted to Children's Hospital La Fe (1971-1996) with a clinical diagnosis of epiglottitis and isolation of the microorganism in blood cultures (20 cases) and surface culture of the epiglotis (one case) are reviewed.


RESULTS
The annual average was 4/100,000 children under 5 years of age. Evolution prior to diagnosis was > 12 hours in 52.4% of the cases. More males were affected (52.4% vs 47.6%). All the children except one (95.2%) were under 5 years of age; 81% were under 3 years of age and 1 child was 6 years and 8 months old. Respiratory distress (100%) and fever > or = 38 degrees C (85.7%) were the most common clinical manifestations. General health was affected in 71.4% of the cases and 66.7% had leucocytosis on admission. The clinical diagnosis was confirmed by direct visualization of the epiglotis in 76.1% of the cases. Hib was isolated in blood culture in 20 cases (95.2%). The strains produced beta-lactamases and were ampicillin-resistant in 57.1%. 19 children (90.5%) required endotracheal intubation. Initial empiric antibiotic therapy was third generation cephalosporins (cefotaxime or ceftriaxone) alone or combined with ampicillin. One child died (4.8%).


CONCLUSIONS
Pediatricians must still be aware of this serious infection in order to diagnosis and treat it as early as possible.
del Carmen Otero
M
M
Sección de Enfermedades Infecciosas Pediátricas, Hospital Infantil La Fe, Valencia.
Sanchís
N
N
Modesto
V
V
Pérez-Tamarit
D
D
Asensi
F
F
Santos
M
M
D000208:Acute Disease; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004826:Epiglottitis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006192:Haemophilus Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006193:Haemophilus influenzae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D007442:Intubation, Intratracheal; D007958:Leukocyte Count; D008297:Male; D010808:Physical Examination; D012189:Retrospective Studies; D013030:Spain
D002511:Cephalosporins
Epiglotitis aguda por Haemophilus influenzae tipo b en niños: presentación de 21 casos.