title: Epiglottitis in the Hemophilus influenzae type B vaccine era: changing trends.
abstract: OBJECTIVE
  To describe the epidemiology, natural history, and treatment of epiglottitis in the Hemophilus influenzae type B (Hib) vaccine era.
  
  
  METHODS
  Ten-year retrospective study.
  
  
  METHODS
  Tertiary-care children's hospital.
  
  
  METHODS
  Nineteen patients with a discharge diagnosis of epiglottitis.
  
  
  METHODS
  As indicated by the presentation of the patient, including direct laryngoscopy, intubation, intravenous antibiotics, and steroids.
  
  
  METHODS
  Presentation, management, and microbiology.
  
  
  RESULTS
  Presenting symptoms included fever, drooling, and hot potato voice. Patients' ages ranged from 15.8 months to 17.5 (mean 8.9) years. From 1992 to 1997, the mean age was 5.8 years; from 1998 to 2002, the mean age was 11.6 years. Sixty-eight percent of patients were transferred from an outside hospital. A lateral neck radiograph was recorded in 84% of patients. Mean leukocyte count was 16600. Direct laryngoscopy with intubation was performed in 79%; intubation was for an average of 3.5 days. H. influenzae was cultured in six patients, five of which had up-to-date immunizations. The most commonly administered antibiotics were ampicillin/sulbactam and ceftriaxone. Steroids were administered to 63% of patients. Complications included deep neck space infection (2), seizure (1), recurrent illness (1), and vocal granuloma (1). There were no deaths.
  
  
  CONCLUSIONS
  The demographics, causative organisms, and natural history of epiglottitis have changed substantially in the Hib vaccination era. The clinician evaluating and treating patients with epiglottitis should be aware of current trends.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tufts-New England Medical Center, Boston, MA, USA.
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
authors.forename: Dwight T
authors.initials: DT
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004826:Epiglottitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D018073:Haemophilus Vaccines; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D018073:Haemophilus Vaccines