A case of acute epiglottitis caused by Haemophilus influenzae type a in an adult

Ashley M Cerqueira,Marina Ulanova,Frances B Jamieson,Raymond S W Tsang

doi:10.1099/jmmcr.0.001552

Abstract

Introduction: Prior to the introduction of a paediatric conjugate vaccine in the early 1990s, Haemophilus influenzae serotype b (Hib) was a major cause of childhood meningitis and pneumonia. Since becoming part of national immunization programmes, the Hib conjugate vaccine has been very successful in preventing invasive Hib disease worldwide. However, in the post‐Hib vaccine era, the emergence of invasive disease caused by non‐type b H. influenzae has been reported from several countries. Previous studies by our group found an increased incidence of invasive disease caused by H. influenzae serotype a in Northwestern Ontario, Canada, during 2002–2011. Most of the cases of invasive H. influenzae type a disease occurred in young children. Case presentation: Our continued surveillance identified a case of epiglottitis caused by H. influenzae type a in a 65‐year old woman. This life‐threatening condition was historically associated with invasive Hib disease in young children but had not previously been reported in association with H. influenzae type a. We describe the clinical presentation of this case as well as characteristics of the H. influenzae type a isolate. Conclusion: Our findings stress the importance of continued surveillance of H. influenzae in the post Hib‐vaccine era, and point to the significance of H. influenzae type a as a cause of severe invasive disease in countries with a universal paediatric anti‐Hib immunization programme.

Highlights

Prior to the introduction of a paediatric conjugate vaccine in the early 1990s, Haemophilus influenzae serotype b (Hib) was a major cause of childhood meningitis and pneumonia
Haemophilus influenzae is a Gram-negative coccobacillus, which can be asymptomatically carried in the nasopharynx, but is capable of causing invasive or local infections, including otitis media, sinusitis, pericarditis, urinary tract infections, septicaemia, septic arthritis, meningitis, pneumonia and epiglottitis (Pittman, 1931; Wenger, 1998)
The use of H. influenzae is serotype b (Hib) conjugate vaccines has substantially decreased the incidence of invasive Hib disease worldwide (Wenger, 1998)

Summary

Introduction

Haemophilus influenzae is a Gram-negative coccobacillus, which can be asymptomatically carried in the nasopharynx, but is capable of causing invasive or local infections, including otitis media, sinusitis, pericarditis, urinary tract infections, septicaemia, septic arthritis, meningitis, pneumonia and epiglottitis (Pittman, 1931; Wenger, 1998). Previous medical history was significant for obesity, diabetes mellitus type 2, hyperlipidaemia and proteinuria, and osteoarthritis She was prescribed Tamiflu at the clinic, but returned the following day with progressive dysphagia and dyspnoea, decreased appetite, severe sore throat, increased neck swelling and drooling. She reported a feeling that her throat was closing and was immediately referred to the emergency department. Serotyping by slide agglutination indicated H. influenzae type a, which was confirmed by detection of serotype-specific capsular polysaccharide synthesis genes. Identification and biotyping of H. influenzae was accomplished by standard biochemical tests (Kilian, 2003), and confirmed by 16S rRNA sequencing (Lau et al, 2004)

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Discussion