Haemophilus influenzae type b strains of outer membrane subtypes 1 and 1c cause different types of invasive disease

Of 275 consecutive Haemophilus influenzae type b (Hib) strains isolated from children with invasive disease in Finland in 1985-86, 74% were of the common European outer membrane protein (OMP) subtype 1 and 22% were of OMP subtype 1c, which is usually rare. Strains of subtype 1c caused proportionately more meningitis and less epiglottis than did strains of subtype 1c. Furthermore, children with disease due to strains of subtype 1c were younger than those with disease due to strains of subtype 1. The significant difference in association between subtype and the diagnosis of epiglottitis or meningitis remained even when the strong influence of age was accounted for. This finding may suggest a true difference in the virulence between these subtypes not previously demonstrated for Haemophilus influenzae type b.

Passive smoking and croup

The relationship between croup and the presence of household cigarette consumption was assessed in a matched-pair case control study. Fifty subjects with a primary hospital discharge diagnosis of croup were paired with children with a primary hospital discharge diagnosis of abdominal hernia. The results yielded an estimated relative risk of 0.82. The power of this study to detect a relative risk of 2.0 was 38%. This study fails to show a relationship between passive smoking and croup in early childhood.

Candida epiglottitis in immunocompromised patients

Candida seldom has been reported to be a cause of epiglottitis. The clinical manifestations and management of three patients with Candida epiglottitis complicating their neoplastic disease are described. All patients were granulocytopenic. Candida epiglottitis occurred either as a localized infection, as a source of Candida bronchopneumonia, or as a manifestation of disseminated infection. Candida epiglottitis may be under-diagnosed and should be considered, especially in immunocompromised patients with symptoms of refractory pharyngitis. Treatment of Candida epiglottitis with intravenous amphotericin B is warranted in patients with sustained granulocytopenia. Prompt endotracheal intubation is indicated if the airway patency cannot be maintained.

Recurring epiglottitis in an adult

We report a case of recurring epiglottitis in an adult. The patient presented with complaints of a sore throat and fever. The presence of a muffled voice led to radiologic and indirect laryngoscopic examination confirming the diagnosis. The patient responded promptly to glucocorticoids and parenteral antibiotics. Over the ensuing six months, he was readmitted to the hospital on three separate occasions with recurrent symptoms and findings of epiglottitis. On each occasion, he responded promptly to therapy. An exhaustive investigation failed to reveal a cause for this unique occurrence of recurring disease.

Candida epiglottitis in an adult with acute nonlymphocytic leukemia

A 40-year-old white woman presented with fever, otalgia, and odynophagia and was found to have a peripheral white blood cell count of 90,000/mm3. A diagnosis of acute myelogenous leukemia was made. Further evaluation of symptoms and source for fever led to the diagnosis of Candida albicans epiglottitis. This is the first reported case of fungal epiglottitis in an immunocompromised adult.

Infectious croup: a critical review

Infectious croup is a viral or bacterial syndrome characterized by a barking cough, hoarseness, and stridor. Three separate conditions will be discussed: laryngotracheobronchitis, spasmotic croup, and bacterial tracheitis. Each clinical entity will be defined and its treatment reviewed. Current treatment regimens for infectious croup involve various combinations of mist therapy, racemic epinephrine, corticosteroids, and syrup of ipecac. Tradition, rather than science, appears to be the basis of many of these treatments. Despite the frequent occurrence of infectious croup, no treatment has proved consistently successful. Prevention and better treatment methods are the keys for reducing the high cost of infectious croup to the medical care system.

Epiglottitis in immunocompromised patients

Modern medical oncology has made dramatic improvements in the prognosis of many malignancies. Many of the treatment regimens used by the chemotherapist have the potential to profoundly depress the immune system. At UCLA Medical Center, three patients developed epiglottitis secondary to the fungus Candida albicans, while profoundly immunocompromised. All three had severe pain and odynophagia. The patients were all managed medically and none went on to airway obstruction. The natural history of this process is reviewed.

Dysphonia

Dysphonia, or hoarseness, is a symptom (not a diagnosis) produced by roughening or abnormal movement of the vocal folds. A diagnosis can only be made by viewing the vocal folds. Because of the excellent prognosis for laryngeal carcinoma that is treated early, all patients who complain of dysphonia deserve to have this diagnosis excluded.

Cricoarytenoiditis: CT assessment in rheumatoid arthritis

The cricoarytenoid (CA) joint is a true diarthrodial joint that can be affected by rheumatoid disease. Its strategic location in the airway anatomy makes its evaluation of clinical importance. Direct fiberoptic laryngoscopy (DFL) and high-resolution computerized tomography (HRCT) were used to assess the larynx in 32 rheumatoid patients. Abnormalities were seen in 75% of patients at endoscopic examination. HRCT studies showed abnormalities in 72%. Erosion-luxation of the CA joint and surrounding soft-tissue swelling can be demonstrated on HRCT scans. A radiologic grading of the rheumatoid larynx is proposed, stressing that accurate evaluation of the larynx should be part of the diagnostic evaluation of every rheumatoid arthritic patient, given the high frequency of occurrence of rheumatoid laryngitis.

Membranous laryngotracheobronchitis, a complication of measles

Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous laryngotracheobronchitis are reported.