Hib vaccine
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Lack of efficacy leading to Haemophilus epiglottitis in a child : case report A 3-year-old boy developed a non-typeable Haemophilus influenzae infection leading to epiglottitis, despite full immunisation against H. influenzae type b [details of Hib vaccine not stated]. The boy presented with a 4-hour history of sore throat and fever. The condition had started 2 days earlier as mild rhinorrhoea and nasal congestion with no other symptoms [time from immunisation to reaction onset not stated]. He showed mild trismus and pharyngeal erythema, and later developed a muffled voice and drooling. His WBC count was 12.4 with 74% segmented neutrophils. A nasopharyngeal swab was positive for respiratory syncytial virus but negative for influenza A and B. A neck x-ray and CT scan revealed thickening of the epiglottis and aryepiglottic folds. His condition worsened as he developed odynophagia, inspiratory stridor and wheezing. He received methylprednisolone, salbutamol [albuterol], epinephrine [adrenaline] and ceftriaxone, which minimally improved his stridor. By the time he was airlifted to hospital, he was in mild respiratory distress with inspiratory stridor. He was brought to the operating room for endotreacheal intubation under anaesthesia. Direct laryngoscopy showed a red, beefy epiglottis. He remained intubated for the next 40 hours and received sulbactam/ ampicillin and vancomycin. On hospital day 2, he received IV dexamethasone. The next day an air leak was noted around the endotracheal tube and he was extubated. Blood culture was positive for non-typeable H. influenzae biotype I. Cultures from the epiglottis grew normal oral flora. Vancomycin was discontinued and he remained on sulbactam/ampicillin. His condition rapidly improved and he was discharged on day 6. Rogers DJ, et al. Epiglottitis due to nontypeable Haemophilus influenzae in a vaccinated child. International Journal of Pediatric Otorhinolaryngology 74: 218-220, No. 2, Feb 2010. Available from: URL: http://dx.doi.org/10.1016/ 803007392 j.ijporl.2009.11.019 - USA
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Reactions 20 Mar 2010 No. 1293
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