Introduction
Haemophilus influenzae is a gram-negative bacteria. H. influenzae serotype b (Hib) was a frequent cause of bacteremia and invasive infections prior to the routine use of Hib conjugate vaccines in children. Though uncommon, breakthrough cases of Hib disease still affect a small proportion of vaccinated children, presumably due to impaired production of memory B cells.
Epiglottitis is an inflammation of the epiglottis and supraglottic structures caused by bacterial invasion, most commonly by Hib. Epiglottitis is a rare but life-threatening condition.
Case Report
A previously healthy and vaccinated 2-year-old girl was admitted to the Pediatric Department due to fever, stridor and cough for several hours. Physical examination revealed tachycardia, tachypnea, pallor and dyspnea with reduced breathing sounds and inspiratory stridor in auscultation. Blood work was remarkable for leukocytosis with elevated Neutrophil count. Chest X-Ray was normal. Few hours later her respiratory distress declined followed by low oxygen saturations (90%), severe dyspnea and perioral cyanosis. During intubation a red swollen epiglottis and larynx was revealed. After transferring to PICU, the girl was treated with adequate Antibiotic due to positive growth of Hib in blood cultures. 3 days later she was successfully extubated and, after further recovery, was discharged from the hospital.
Conclusion
We presented a rare case of epiglottitis, caused by Hib, in a fully vaccinated child that rapidly progressed to a life-threatening airway obstraction, and required prompt intubation. This unique case demonstrates that high clinical suspicion for invasive Hib infection is crucial, despite the well known efficacy of the conjugated Hib vaccine.
