INCIDENCE, ETIOLOGY, AND PROGNOSIS OF ACUTE EPIGLOTTITIS IN CHILDREN AND ADULTS IN SWEDEN

A retrospective study of the incidence, aetiology and case fatality ra te of acute epiglottitis in children and adults was performed. The stu dy covered the whole of Sweden (population 8.4 million) during the yea rs 1987-89, before general vaccination against Haemophilus influenzae (Hi) type b was started. Patients were included if it was documented t hat they fulfilled all 3 of the following criteria: (a) red and swolle n epiglottis visualized by indirect laryngoscopy, (b) inspiratory stri der or difficulties in swallowing, and (c) a temperature greater than or equal to 38 degrees C. A total of 306 children and adolescents (0-1 9 years) and 502 adults (greater than or equal to 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 (greater than or equal to 20 years), 114 of 298 blood cultures yielded Hi, while pneumo cocci 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 incidenc e of acute epiglottis in Sweden is very high. Compared to a previous c ountry-wide study covering the years 1981-83 that used the same method s for case finding and case definition, the incidence in children had decreased while the incidence in adults had increased.