Etiology of Acute Infectious Epiglottitis in Adults: Septic vs. Local Infection

Abstract

Adult patients with acute epiglottitis hospitalized between 1975 and 1988 were retrospectively analysed. 79 of 138 patients had a valid diagnosis and had delivered at least one blood culture and were considered eligible for further evaluation. Cultures from the upper airways, including epiglottis, were available in 43 of the patients as a consequence of prospective measures. 27% of the patients had bacteremia, which may however be an overestimation. Haemophilus influenzae was the predominating finding, but Streptococcus pneumoniae was isolated from 3 severely ill patients, indicating the existence of pneumococcal epiglottitis at a rate of less than 5%. From the non-bacteremic patients with a localized disease, either H. influenzae or beta-hemolytic streptococci were isolated from the epiglottis in one third of the cases. The distribution of pathogens in upper airways indicates that beta-hemolytic streptococci may have an etiological role in acute infectious epiglottitis. Except for H. influenzae, species with the potential ability of beta-lactamase production have no significance in the disease.

Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilus influenzae type b disease

“…11,15 In adults, other pathogens responsible for causing epiglottitis, in addition to Hib, include Streptococcus pneumoniae, beta-haemolytic Streptococci and Staphylococcus aureus. 16 In adults over 20 years old, Hib was identified in 11% (2) cases of clinical epiglottitis in the pre-vaccine era in this study, similar to other reports. 17,18 Trolfors et al 19 and Mayo-Smith et al 11 report a 27 and 8% incidence, respectively, of any positive bacteriological examination in adults with epiglottitis, and Trolfors et al noted that Hib was isolated in 17% of blood cultures in adults with suspected epiglottitis.…”

The management of acute supraglottitis patients at the intensive care unit

“…The most common etiologic agent is Haemophilus influenza. Other etiological organisms include Streptococcus pneumonia, other Streptococcus species, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas species, and Neisseria species [1][2][3][4]. Despite this, bacteria are rarely isolated due to the difficulty of obtaining cultures from the epiglottis.…”