Forensic Science, Medicine and Pathology

, Volume 14, Issue 4, pp 555–557 | Cite as

Sudden death from acute epiglottitis in a toddler

  • Ann Sophie SchröderEmail author
  • Carolin Edler
  • Jan Peter Sperhake
Images in Forensics


The bacterium Haemophilus influenzae type b (Hib) can cause severe and life-threatening infections such as epiglottitis and meningitis. The course of the disease can be very rapid, resulting in sudden death. The incidence of Hib-induced epiglottitis in children has declined since the introduction of vaccinations in countries where such vaccinations are routinely administered. We herein present a case involving a 2.5-year-old boy who died suddenly at home. He had developed acute-onset throat and abdominal pain and a high fever. Despite an emergency cricothyrotomy due to a complicated intubation because of a massively swollen epiglottis, the efforts to resuscitate the child were unsuccessful. He was a previously healthy toddler, but he had not yet been vaccinated. Microbiologic analysis revealed the pathogenic bacterium Hib. The main autopsy finding was acute epiglottitis with swelling and cherry-red coloring of the epiglottis. Postmortem cultures of the cerebrospinal fluid and heart blood also revealed Hib as the pathogenic agent. Acute pneumonia was also diagnosed microscopically. The present report describes a rare case of Hib-induced acute epiglottitis and presents the key findings of forensic investigations in this type of disease.


Haemophilus influenzae type b Hib Sudden death Epiglottitis Vaccination 



We thank Angela Morben, DVM, ELS, from Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Eisenmenger W, Beckmann G, Tröger HD. Kehlkopfveränderungen und plötzlicherTod. Z Rechtsmed. 1975;76:321–33.CrossRefGoogle Scholar
  2. 2.
    Siboni A, Simonsen J. Sudden unexpected natural death in young persons. Forensic Sci Int. 1986;31:159–66.CrossRefGoogle Scholar
  3. 3.
    Nadjem H, Lohner M. Unerwartete Todesfälle im Kindesalter durch akute Epiglottitis. Beitr Gerichtl Med. 1992;50:205–9.PubMedGoogle Scholar
  4. 4.
    Wood N, Menzies R, McIntyre P. Epiglottitis in Sydney before and after the introduction of vaccination against Haemophilusinfluenzae type b disease. Intern Med J. 2005;35:530–5.CrossRefGoogle Scholar
  5. 5.
    Takala AK, Peltola H, Eskola J. Disappearance of epiglottitis during large-scale vaccination with Haemophilusinfluenzae type b conjugate vaccine among children in Finland. Laryngoscope. 1994;104:731–5.CrossRefGoogle Scholar
  6. 6.
    Tanner K, Fitzsimmons ED, Carrol ED, Flood TJ, Clark JE. Haemophilusinfuenzae type b epiglottitis as a cause of acute upper airway obstruction in children. BMJ. 2002;325:1099–100.CrossRefGoogle Scholar
  7. 7.
    Robert Koch Institut. Invasive Haemophilus influenza-Infektionen in Deutschland. Epidemiol Bull. 2011;14:105–16.Google Scholar
  8. 8.
    Watts JP, Wolfson LJ, O’Brian K, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Haemophilus influenza type b in children younger than 5 years: global estimates. Lancet. 2009;374:903–11.CrossRefGoogle Scholar
  9. 9.
    Bellins M, Herath J, Pollanen MS. Sudden death due to acute epiglottitis in adults: a retrospective review of 11 postmortem cases. Am J Forensic Med Pathol. 2016;37:275–8.CrossRefGoogle Scholar
  10. 10.
    Trübenbach T, Töllner U. Akute epiglottitis bei kindern: Probleme der früherkennung und therapie. Dtsch Arztebl. 1983;80:A-47.Google Scholar
  11. 11.
    Tsokos M, Mack D, Püschel K. Postmortalebakteriologische diagnostik. entnahmetechnik, untersuchungsmaterial, limitierende faktoren, diagnostische wertigkeit und interpretation. Rechtsmedizin. 2002;12:59–64.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ann Sophie Schröder
    • 1
    Email author
  • Carolin Edler
    • 1
  • Jan Peter Sperhake
    • 1
  1. 1.Department of Legal MedicineUniversity Medical Center Hamburg–EppendorfHamburgGermany

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