To: aknahow who wrote (10650 ) 7/7/1999 9:01:00 PM From: Tharos Respond to of 17367
MENINGOCOCCAL SUPRAGLOTTITIS INCIDENCE MAY BE ON THE RISEid.medscape.com WESTPORT, Jun 30 (Reuters Health) - The incidence of supraglottitis caused by Neisseria meningitidis appears to increasing worldwide, according to a report in the May-June issue of Emerging Infectious Diseases. Drs. Eric Schwam of Sturdy Memorial Hospital in Attleboro, Massachusetts, and Jeffrey Cox, of Rhode Island Hospital in Providence, Rhode Island, report the case of a 44-year-old woman who presented to the emergency room with fever and severe neck swelling accompanied by difficulty in swallowing and breathing. Computed tomography showed "...extensive soft tissue swelling from the oropharynx to the supraglottic region with obliteration of the airway surrounding the endotracheal tube." The patient was treated with intravenous antibiotics, epinephrine, oxygen, and oral intubation. The swelling resolved by day 7, and the patient was released on day 9 and treated at home with intravenous ampicillin-sulbactam for 1 week. Blood taken before antibiotics were given cultured N. meningitidis sensitive to both penicillin and ceftriaxone, but resistant to tetracycline. Drs. Schwam and Cox note that only five other cases of meningococcal supraglottitis have been cited on Medline, all since 1995. The five cases involved women older than 40 years of age, four of whom required either intubation or tracheostomy. Supraglottitis is more frequently caused by Haemophilus influenzae. Drs. Schwam and Cox point out that "...while one case [of meningococcal supraglottitis] was reported each year from 1995 to 1997, three cases have been reported in 1998-1999, from three continents." These cases may suggest "...the emergence of a new meningococcal syndrome worldwide," the authors conclude, calling for clinical surveillance to "...determine if meningococcal supraglottitis will become more than just a rarity." Emerg Infect Dis 1999;5:464-466.