Incidence, Aetiology, and Prognosis of Acute Epiglottitis in Children and Adults in Sweden

Abstract

A retrospective study of the incidence, aetiology and case fatality rate of acute epiglottitis in children and adults was performed. The study covered the whole of Sweden (population 8.4 million) during the years 1987–89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented that they fulfilled all 3 of the following criteria: (a) red and swollen epiglottis visualized by indirect laryngoscopy, (b) inspiratory stridor or difficulties in swallowing, and (c) a temperature ≥ 38°C. A total of 306 children and adolescents (0–19 years) and 502 adults (≥ 20 years) were found. The age-specific incidence was highest in children aged 0–4 years, (14.7/100,000 per year). The total incidence was 3.2/100,000 per year. In the age group 0–19 years, blood cultures had been obtained from 195 (64%) and Hi was isolated from 154 (79%). In adults (≥ 20 years), 114 of 298 blood cultures yielded Hi, while pneumococci were isolated from 5 and group A streptococci from 3 patients. A total of 220 children (72%) and 114 adults (23%) needed an artificial airway. Five children and 12 adults died. In conclusion, the incidence of acute epiglottis in Sweden is very high. Compared to a previous country-wide study covering the years 1981–83 that used the same methods for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.