Læknablaðið - 15.06.2010, Blaðsíða 23

FRÆÐIGREINAR
RANNSÓKNIR
bólusetning hefur ekki haft áhrif á nýgengi
sjúkdómsins hjá fullorðnum sem hugsanlega fer
vaxandi og sjúkdómurinn er líklega algengastur
yfir vetrarmánuðina samkvæmt okkar niður-
stöðum. Þegar kemur að meðferð bráðrar
barkabólgu er mikilvægt að hafa í huga hættu
á lokun öndunarvega vegna bólgu. Góð klínísk
dómgreind er nauðsynleg til að greina milli
sjúklinga sem þurfa tafarlausa innlögn á gjörgæslu
og ef til vill meðhöndlun með barkaþræðingu/
barkaskurði og sjúklinga sem hægt er að vakta
á venjulegri legudeild. Það er okkar reynsla að
hægt sé að vakta sjúklinga með væg-meðalvæg
einkenni án öndunarfæraíhlutunar með góðum
árangri.
Þakkir
Þakkir fá Örn Ólafsson tölfræðingur og Þórólfur
Guðnason læknir hjá landlæknisembættinu.
Heimildir
1. Berger G, Landau T, Berger S, Finkelstein Y, Bemheim J,
Ophir D. The rising incidence of adult epiglottitis and
epiglottic abscess. Am J Otolaryngol 2003; 24: 374-83.
2. Chang YL, Lo SH, Wang PC, Shu YH. Adult acute epiglottitis:
experiences in a Taiwanese setting. Otolaryngol Head Neck
Surg 2005; 132: 689-93.
3. Frantz TD, Rasgon BM, Quesenberry jr CP. Acute epiglottitis
in adults: analysis of 129 cases. JAMA1994; 272:1358-60.
4. Kass EG, McFadden EA, Jacobson S, Toohill RJ. Acute
epiglottitis in the adult: experience with a seasonal
presentation. Laryngoscope 1993; 103: 841-4.
5. Kucera CM, Silverstein MD, Jacobson RM, Wollan PC,
Jacobsen SJ. Epiglottitis in adults and children in Olmsted
county, Minnesota, 1976 through 1990. Mayo Clin Proc 1996;
71:1155-61.
6. Mayo-Smith MF, Hirsch PJ, Wodzinski SF, Schiffman FJ.
Acute epiglottitis in adults. an eight-year experience in the
state of Rhode Island. N Engl J Med 1986; 314:133-9.
7. Mayo-Smith MF, Spinale JW, Donskey CJ, Yukawa M, Li RH,
Schiffman FJ. Acute epiglottitis: an 18-year experience in
Rhode Island. Chest 1995; 108:1640-7.
8. Shah RK, Roberson DW, Jones DT. Epiglottitis in the
Hemophilus influenzae type b vaccine era: changing trends.
Laryngoscope 2004; 114: 557-60.
9. Wong EYH, Berkowitz RG. Acute epiglottitis in adults: the
Royal Melboume Hospital experience. ANZ J Surg 2001; 71:
740-3.
10. Adams WG, Deaver KA, Cochi SL, et al. Decline of childhood
Haemophilus influenzae type b (Hib) disease in the Hib
vaccine era. JAMA1993; 269: 221-6.
11. Alho OP, Jokinen K, Pirila T, Ilo A, Koivunen P. Acute
epiglottitis and infant conjugate Haemophilus influenzae
type b vaccination in Northern Finland. Arch Otolaryngol
Head Neck Surg 1995; 121: 898-902.
12. Garpenholt O, Hugosson S, Fredlund H, Bodin L, Olcén
P. Epiglottitis in Sweden before and after introduction of
vaccination against Haemophilus influenzae type b. Pediatr
Infect Dis J 1999; 18: 490-3.
13. McEwan J, Giridharan W, Clarke RW, Shears P. Paediatric
acute epiglottitis: not a disappearing entity. Int J Pediatr
Otorhinolaryngol 2003; 67: 317-21.
14. Midwinter KI, Hodgson D, Yardley M. Paediatric epiglottitis:
the influence of the Haemophilus influenzae b vaccine, a ten-
year review in the Sheffield region. Clin Otolaryngol 1999;
24: 447-8.
15. Murphy TV, White KE, Pastor P, et al. Declining incidence of
Haemophilus influenzae type b disease since introduction of
vaccination. JAMA1993; 269: 246-8.
16. Peltola H. Haemophilus influenzae type b disease and
vaccination in Europe: lessons learned. Pediatr Infec Dis J
1998;17(9):S126-32.
17. Tanner K, Fitzsimmons G, Carrol ED, Flood TJ, Clark JE.
Haemophilus influenzae type b epiglottitis as a cause of
acute upper airways obstruction in children. BMJ 2002; 325:
1099-100.
18. Valdepena HG, Wald ER, Rose E, Ungkanont K, Casselbrant
ML. Epiglottitis and Haemophilus influenzae immunisation:
the Pittsburgh experience - a five-year review. Paediatr 1995;
96: 424-7.
19. Wood N, Menzies R, Mclntyre P. Epiglottitis in Sydney
before and after the introduction of vaccination against
Haemophilus influenzae type b disease. Int Med J 2005; 35:
530-5.
Acute epiglottitis in lceland from 1983-2005
Objective: To describe the changes in the epidemiology of
acute epiglottitis in lceland from 1983-2005.
Methods: All patients with discharge diagnosis of epiglottitis
during the study years were identified and diagnosis
confirmed by chart review. Main outcome measures were
age, gender, month/year of diagnosis, microbiology, airway
management, ICU admissions, choice of antibiotics, length
of hospital stay and major complications/mortality.
Results: Fifty-seven patients were identified (annual
incidence 0.93/100.000). The mean age was 33.3 years
(1 -82). Childhood epiglottitis disappeared after introduction
of Haemophilus influenzae type b (Hib) vaccination in 1989
but adult disease showed non-significant increase. In the
pre-vaccination era Hib was the most common organism
cultured but it has not been diagnosed in lceland since 1991
and Streptococci are now the leading cause of epiglottitis.
The mean hospital stay was 5.05 nights with 51 % of
patients admitted to ICU. All children under 10 years and a
total 30% of patients received ainvay intervention. Ninety
percent of adults were observed without ainway intervention.
Major complications were rare and mortality was 0% in our
series.
Conclusion: There have been major changes in the
epidemiology of epiglottitis in lceland during the study
period. Previously a childhood disease, epiglottitis has
disappeared in children and is now almost exclusively
found in adults. This can be attributed to widespread
Hib vaccination, eliminating the major causative agent
in children. The treatment of this life-threatening disease
remains a challenge. Our series suggest that it is safe to
observe patients with mild/moderate symptoms without
airway intervention.
Briem B, Thorvardarson O, Petersen H
Acute epiglottitis in lceland from 1983-2005. Icel Med J 2010; 96:407-13
Keywords: case study, epidemiology, epiglottitis, Haemophilus influenzae type b, vaccination.
Correspondence: Hannes Petersen, hpet@landspitali.is
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Barst: 17. ágúst 2009, - samþykkt til birtingar: 6. maí 2010
Hagsmunatengsl: Engin
LÆKNAblaðið 2010/96 41 1