Abstract Introduction Hemophilus Influenza (H. influenzae) bacteremia is rarely diagnosed but when it is diagnosed, it can cause life-threatening infections with significant mortality. Risk factors for bacteremia include childhood, impaired immune function, malignancy, and asplenia. We describe a case of H. influenza bacteremia and epiglottitis in an elderly female. Case Description 81-year-old female with PMH of hypertension, hypothyroidism, well controlled T2DM who presented with sore throat and shortness of breath. She was afebrile and initial labs were concerning for sepsis. Rapid strep testing, Covid, flu, and full respiratory viral panel testing were negative. Chest x-ray was unremarkable as well. Later in the ED, the patient was noted to be in mild respiratory distress with tachypnea, dysphagia, and dyspnea, so was transferred to ICU. On arrival at the unit, she rapidly decompensated with worsening stridor and hypophonia. She received racemic epinephrine with IV Decadron and a STAT CT of the neck (Picture1) showed the edematous appearance of the epiglottis and bilateral aryepiglottic folds concerning acute epiglottitis and left lower face and upper neck cellulitis. She immediately underwent bronchoscopy assisted awake intubation for airway protection. She started on broad spectrum IV antibiotics and steroids. Her blood cultures came back positive for H. Influenza and antibiotics deescalated. She was subsequently extubated and transitioned to oral antibiotics and later discharged. Discussion H. Influenzae is a common cause of a variety of invasive and non-invasive bacterial infections, mostly in children and immunocompromised patients. While it is common for H. Influenzas to cause pneumonia and meningitis, it is very rare to cause epiglottitis (1) in a considerably non immunocompromised patient like in our case. Though vaccine is known to decrease risk of H. Influenza its mainly against type b (2) and not the nontypeable ,which according to available literature, is on the rise with more reported cases affecting the older population and carrying risk of high fatality of 19.5% (3). Conclusion The epidemiology of H. Influenza is shifting. Older populations (4) are having severe forms of invasive H. Influenzae and life-threatening consequences which require the awareness of physicians to suspect and manage it early to avoid the high rate of fatality it can cause. This abstract is funded by: none
Annan et al. (Fri,) studied this question.