Sex: F
Vaccine: HIBV
Symptoms: Epiglottitis, Inflammatory marker test, Influenza virus test negative, Intensive care, Malaise
Clinical narrative: This case was reported in a literature article and described the occurrence of epiglottitis in a 4-year-old female patient who received HIB vaccine. On an unknown date, the patient received HIB vaccine at an unknown dose. On an unknown date, an unknown time after receiving HIB vaccine, the patient experienced epiglottitis (serious criteria hospitalization and GSK medically significant), candida infection (serious criteria hospitalization), feeling unwell (serious criteria hospitalization), sore throat (serious criteria hospitalization), decreased appetite (serious criteria hospitalization), crying (serious criteria hospitalization), and drooling (serious criteria hospitalization). The patient was treated with Cephalosporin and fluconazole. On an unknown date, the outcome of the epiglottitis, candida infection, feeling unwell, sore throat, decreased appetite, crying and drooling were recovered/resolved. The reporter considered the epiglottitis, candida infection, feeling unwell, sore throat, decreased appetite, crying and drooling to be related to HIB vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of acute Candida epiglottitis in 4-year-old female who was vaccinated with unspecified HIB vaccine (manufacturer unknown). The patient was a healthy and immunocompetent female. No information on patient's family history or concomitant medication or concurrent condition was provided. On an unspecified date, the patient received unspecified HIB vaccine (administration route and site unspecified; dosage unknown; batch number not provided). The patient was up to date for recommended immunisations. On an unspecified date, unknown period after vaccination, the patient was presented in the late evening to the emergency department for evaluation. The patient's mother provided a 2-day history of the patient feeling ill, having a sore throat, and having a decreased appetite. Fever, nasal congestion, vomiting, weight loss, and sick contacts were denied. Upon initial examination, her vital signs included a temperature of 37.1 deg.C, a heart rate of 123, respirations of 20, and room air pulse oximetry of 100%. Generally, the patient was awake, interactive, well perfused, and ill appearing. She was sitting upright on the stretcher with no flexion of the neck, intermittently crying, and occasionally drooling. The head, eye, ear, nose, and throat examination was notable for clear oral secretions, muffled voice, 1 positive symmetrically appearing tonsillar pillars absent of exudates, and a normal-appearing uvula. The epiglottis was not visualized on the examination. A neck examination demonstrated unremarkable external landmarks, no tenderness to palpation, and auscultation was without stridor. An abdominal examination was performed in semi-recumbent position so as not to induce respiratory distress. The rest of her physical examination was unremarkable. A differential diagnosis that included epiglottitis, pharyngitis, retropharyngeal abscess, and tracheitis was formulated. Diagnostic testing included negative rapid antigen testing for group A streptococcus, influenza, and other respiratory viruses. Her white blood cell count was measured to be 14,000 and composed of 65% neutrophils (normal range not provided). The inflammatory marker, C-reactive protein, was measured at 47 (normal range not provided). A portable lateral neck radiograph was obtained. The radiogram was interpreted to display evidence of an enlarged epiglottis that was consistent with the so-called "thumb sign" associated with acute epiglottitis. Third-generation cephalosporin was administered simultaneously with urgent consultation from an otolaryngologist. The consulting surgery team transferred the patient to the operating room where she was examined using a flexible endoscope. The patient's epiglottis appeared "indurated, beefy and red." Also of note was the presence of white patches along the adjacent airway structures, including the supraglottic and aryepiglottic tissues. Intraoperative culture specimens were obtained. The airway was secured with an endotracheal tube for mechanical ventilation. The patient was taken to the paediatric intensive care unit for recovery and supportive care. Additional antimicrobial agents were added to her treatment plan, including the antifungal drug, fluconazole. The patient remained mechanically ventilated for 2 day and was extubated without difficulty. Cultures obtained from the epiglottis yielded Candida ablicans. Antibacterial agents were discontinued. The antifungal agent was continued for a total of 10 days. After hospital discharge, the patient was seen in follow-up where she was noted to have returned to her previous state of health and wellness. Additional diagnostics failed to identify unrecognized genetic and immunodeficiency diseases. This case has been considered serious due to hospitalisation. The authors did not comment on the relationship between the event of acute Candida epiglottitis and unspecified HIB vaccine. The authors concluded that "The rare presentation of Candida epiglottitis is not typical for bacterial epiglottitis, is highly variable, and is usually found only in the patient who is immunocompromised. The atypical nature of this disease poses challenges to the evaluating emergency medicine providers, which underscore the need to maintain vigilance for the potential life and airway threats in their patient's differential diagnosis. Early consideration of the diagnosis, urgent otolaryngology consultation, avoidance of airway-threatening actions, and initiating empiric therapy are critical issues that an emergency medicine practitioner must address. In doing so, the risks of the complications from epiglottitis, including laryngeal scarring and disseminated infection, are managed".