Fulminant supraglottitis from Neisseria meningitidis

Meningococcal serogroup W135 epiglottitis in an adolescent patient

Acute epiglottitis is a severe and potentially life-threatening condition. Since the implementation of Haemophilus influenzae vaccination, the number of cases of epiglottitis has decreased and the proportion of other infectious causes has increased. We report a case of acute epiglottitis in a teenager caused by Neisseria meningitidis, an unusual pathogen.

Resurgence of Vaccine-Preventable Diseases in the United States: Anesthetic and Critical Care Implications

Vaccine-preventable diseases (VPDs) such as measles and pertussis are becoming more common in the United States. This disturbing trend is driven by several factors, including the antivaccination movement, waning efficacy of certain vaccines, pathogen adaptation, and travel of individuals to and from areas where disease is endemic. The anesthesia-related manifestations of many VPDs involve airway complications, cardiovascular and respiratory compromise, and unusual neurologic and neuromuscular symptoms. In this article, we will review the presentation and management of 9 VPDs most relevant to anesthesiologists, intensivists, and other hospital-based clinicians: measles, mumps, rubella, pertussis, diphtheria, influenza, meningococcal disease, varicella, and poliomyelitis. Because many of the pathogens causing these diseases are spread by respiratory droplets and aerosols, appropriate transmission precautions, personal protective equipment, and immunizations necessary to protect clinicians and prevent nosocomial outbreaks are described.

A new era in supraglottitis? An isolated UK case of supraglottitis secondary toNeisseria meningitidis

Objective:

We report the first UK case of supraglottitis secondary toNeisseria meningitidis.

Method:

Case report with review of the current literature on supraglottitis and its aetiology.

Results:

An 89-year-old woman was referred with worsening symptoms of dysphagia, hoarseness and neck discomfort. After nasopharyngoscopy and neck X-ray, supraglottitis was diagnosed. Prompt treatment comprised nebulised adrenaline, oxygen therapy and intravenous antibiotics. Microbiology samples grewN meningitidis, a notifiable disease in the UK. Public health officials were informed, and full precautions and prophylactic treatment initiated for those at risk. The patient made excellent progress and was discharged several days later.

Discussion and conclusion:

Supraglottitis occurs in <4 per 100 000 population. Following a successful UK childhood immunisation programme, most cases occur in adults. Supraglottitis secondary toN meningitidisis exceptionally rare, with only seven other reported cases worldwide. Morbidity is exceptionally high; over 60 per cent of patients require airway intervention. To our knowledge, this is the first reported UK case of supraglottitis secondary toN meningitidis. This case highlights the important clinical, diagnostic and therapeutic interventions required to prevent complications associated with this potentially fatal condition.