1/16. Intrafamily spread of Haemophilus type b infections.meningitis and epiglottitis are the clinical manifestations of severe haemophilus influenzae serotype b infection. Compared with meningitis, epiglottitis occurs in older children. When secondary cases occur within the family, the type of clinical manifestation produced by this serotype is generally similar in siblings. This report concerns the unusual occurrence of meningitis developing in older child and epiglottitis developing in the younger one. We discuss the possible explanations for this unusual pattern. We also survey the spread of H influenzae both within and outside the family unit and review the present status of histocompatibility antigens and Haemophilus disease.- - - - - - - - - - ranking = 1keywords = meningitis (Clic here for more details about this article) |
2/16. haemophilus influenzae infections in adults: report of nine cases and a review of the literature.haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. in vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.- - - - - - - - - - ranking = 1.4283142822436keywords = pneumoniae, meningitis (Clic here for more details about this article) |
3/16. Atypical epiglottitis.early diagnosis of acute epiglottitis may be difficult in the child presenting atypically. The cases of four patients who displayed atypical presentation are reported. The initial diagnosis in three children was croup and in one, pharyngitis. In the fourth patient, a child who had coexisting meningitis, epiglottitis was an incidental finding. All patients recovered with no sequelae.- - - - - - - - - - ranking = 0.5keywords = meningitis (Clic here for more details about this article) |
4/16. Approach to supraglottitis.In my experience, steroids have no use in the management of ACSOL once the airway is secured, and may actually prolong and complicate the infectious process. The main use of antibiotics is probably for preventing systemic complications such as pneumonia and meningitis. It is possible, however, that neither drug can alter the natural course of this disease and may just hasten its expected inconsequential resolution. The key to successful management of acute supraglottitis is early recognition and prompt provision of airway assistance when indicated. This potentially fatal disease occurs in adults as well as children. To my knowledge, most deaths occur after the patient arrives at the hospital, when there is hesitation and indecision about the need for airway intervention. Whenever signs of UAO appear, artificial airway should be provided promptly, regardless of the eventual diagnosis. Those physicians who try all means to avoid intubation or tracheotomy early in the process may be cautioned that complications from either procedures are just a risk, while airway obstruction in most cases of ACSOL is a certainty. Finally, the examiner assessing patients with possible obstructive laryngitis, supraglottic, or subglottic, should first and foremost decide whether an airway is needed and should defer all diagnostic guesswork and laboratory data processing until the airway is secured.- - - - - - - - - - ranking = 0.5keywords = meningitis (Clic here for more details about this article) |
5/16. Acute uvulitis associated with epiglottitis.Acute infectious uvulitis is a rare condition. A case caused by streptococcus pneumoniae occurred in a 56-year-old woman who also had coexisting epiglottitis. One other case of uvulitis reported in the literature has also been associated with acute epiglottitis. Because of potentially lethal complications, epiglottitis should be suspected in any patient who presents with acute painful swelling of the uvula.- - - - - - - - - - ranking = 0.9283142822436keywords = pneumoniae (Clic here for more details about this article) |
6/16. Complication of acute epiglottitis.Acute airway obstruction secondary to supraglottic inflammation is a regional manifestation of epiglottitis in children. Pneumonia, meningitis, cervical adenitis and septic shock are systemic manifestations which can complicate the course of acute epiglottitis. Prompt airway control and institution of appropriate high dose i.v. antibiotics are both important to continue to decrease the morbidity and mortality associated with the regional and systemic manifestations of acute epiglottitis in children.- - - - - - - - - - ranking = 0.5keywords = meningitis (Clic here for more details about this article) |
7/16. Group A streptococcal supraglottitis.We describe four children with severe supraglottic infections caused by group A beta-hemolytic streptococci. In each case the clinical presentation suggested Hemophilus influenzae epiglottitis. In only one patient was there significant involvement of the epiglottis, whereas all had striking inflammation of the aryepiglottic folds. Group A beta-hemolytic streptococcus was isolated in blood cultures in two patients and from the supraglottic area and trachea in two others. fever persisted for 6 to 22 days, and tracheal intubation was necessary for 2 to 16 days, despite appropriate antibiotic therapy. The evolution of streptococcal supraglottitis may be protracted, and it must be managed accordingly.- - - - - - - - - - ranking = 1.913724294771keywords = streptococcus (Clic here for more details about this article) |
8/16. supraglottitis and Hemophilus parainfluenzae: pathogenic potential of the organism.Hemophilus parainfluenzae may be a normal inhabitant of the pharynx, but it can have pathogenic potential elsewhere in the body. It has been identified as a cause of bacteremia and meningitis. The case discussed here represents the first report of H parainfluenzae-induced supraglottitis in a child. In reviewing its pathogenic potential in the upper respiratory tract, it appears that its major effect could be the ability to transfer ampicillin resistance to ampicillin-susceptible Hemophilus influenzae.- - - - - - - - - - ranking = 0.5keywords = meningitis (Clic here for more details about this article) |
9/16. supraglottitis and concurrent Hemophilus meningitis.Acute epiglottitis is a true pediatric emergency. The intense inflammation of the supraglottic larynx may completely obstruct the larynx within several hours. This infection is secondary to infiltration of Hemophilus influenzae type b (HIB), and 90% to 95% of patients have positive blood cultures. During this period of generalized septicemia HIB involvement of other soft tissue sites may occur. The goal of this article is to alert otolaryngologists to the possibility of extraepiglottitic HIB involvement. In particular, HIB meningitis, concurrent with supraglottitis, will be discussed. Although the overall incidence of multiple site involvement is relatively low, it is important to be aware of the possibility, since the outcome may be significantly altered.- - - - - - - - - - ranking = 2.5keywords = meningitis (Clic here for more details about this article) |
10/16. Acute epiglottitis in adults.We treated four adults whose upper airway was compromised due to acute epiglottitis. We also reviewed the English literature for all reports of this condition in adults (18 years and older). Among the 158 cases, the infectious etiology was identified in 29 (H. influenzae 20, streptococcus pneumoniae six, H. parainfluenzae two, streptococcus pyogenes one). In the remaining cases, the etiology was uncertain. bacteremia was documented in 23/32 patients (71.9%), but extra-epiglottic infections were strikingly rare (X = six). The clinical manifestations were sore throat (100%), fever (88%), dyspnea (78%), dysphagia (76%), anterior neck cellulitis or tenderness (27%), hoarseness (21%), pharyngitis (20%) and anterior cervical lymphadenopathy (9%). Complete airway obstruction ensued in 23 out of the 119 subjects (18.3%) who had respiratory difficulty. overall mortality rate was 17.6% but it was 6.4% among the patients who were semi-electively tracheostomized or endotracheally intubated. These findings illustrate that antibiotics therapy active against H. influenzae is required in the treatment of acute epiglottitis in adults. Additionally, airway patency should be established when inspiratory stridor appears assuring uncomplicated recovery.- - - - - - - - - - ranking = 0.9283142822436keywords = pneumoniae (Clic here for more details about this article) |
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