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Introduction
Acute epiglottitis is a potentially life-threatening infection with septic characteristics. It was previously considered to be a childhood disease. A typical feature of the disease was a drooling child sitting upright and leaning forward to make breathing easier. However, during the 1980s cases in adults began to be reported.1 After the introduction of general Haemophilus influenzae type b (Hib) vaccination in children, the disease became rare, and now affects adults almost exclusively.2 In adults, examination can be performed either indirectly with a larynx mirror or (preferably) directly with a flexible nasolaryngoscope. The disease is treated with intravenous antibiotics (cefotaxime) and by securing the airway in an intensive care unit. Airway management often requires endotracheal intubation. Before general Hib vaccination was introduced in Sweden in 1993, the incidence of epiglottitis was 10-14 cases/100 000/year for children (< or =14 years), 1.8-2.3 cases/100 000/year for adults and 3.2-4.5 cases/100 000/year for all ages.3,4 In the general vaccination programme, children are vaccinated at three, five and 12 months of age.
The aims of this study were (1) to investigate the incidence and age distribution of acute epiglottitis in a well defined population, following the introduction of general childhood Hib vaccination, and (2) to study changes in the bacterial epidemiology of the disease. For comparison, a corresponding study in the same population has been published, which was conducted before the introduction of Hib vaccination.3 The age-specific incidence found by the pre-vaccination study is shown in Table I. In a preliminary study of this population conducted in the first few years of the general Hib vaccination programme, we found a decreased overall incidence of acute epiglottitis, along with increased aetiological importance of Streptococcus pneumoniae.5 Consequently, an objective of the present study was to analyse the S pneumoniae serotypes involved in acute epiglottitis.
Table I
Acute epiglottitis incidence in örebro county, before* and after[dagger] general hib vaccination
* 1975-1992;
[dagger]
1993-2008. Hib = Haemophilus influenzae type b; AE = acute epiglottitis
Materials and methods
We reviewed the medical records of patients from Örebro County, Sweden, who were diagnosed with acute epiglottitis (International Classification of Disease code J05.1) between 1993 and 2008 at Örebro University Hospital....