The bacterial agents that cause most cases of uvulitis in children are Haemophilus influenzae type b and Streptococcus pyogenes. Uvulitis caused by H. influenzae may occur concurrently with epiglottitis or as an isolated site of infection. Uvulitis caused by S. pyogenes appears to occur always in concert with pharyngitis. Two cases of uvulitis and associated epiglottitis caused by Streptococcus pneumoniae have been reported in adults. Two cases of uvulitis caused by anaerobic bacteria have been reported: One was caused by Fusobacterium nucleatum and the other by Prevotella intermedia. Another cause of uvulitis in children is Candida albicans. Two cases occurred in immunocompetent infants.

The epidemiology of uvulitis is the epidemiology of its two etiologic agents: S. pyogenes and H. influenzae type b. As such, it can be seen in the school-aged child of between 5 and 15 years (the so-called streptococcal age group) in association with pharyngitis. Similarly, it was seen in the “H. influenzae age group” of 3 months to 5 years before universal immunization with conjugate vaccines for H. influenzae type b. Cases of uvulitis in association with epiglottitis have been reported in the United States as well as in England. Virtually all cases of bacteremic illness caused by H. influenzae type b, including uvulitis and epiglottitis, have disappeared since universal immunization of infants in 1991. Infections caused by S. pyogenes and H. influenzae occur primarily in winter and spring, but both can occur throughout the year.

Uvulitis is an acute cellulitis characterized by dramatic swelling and erythema. Infection of the uvula probably arises from direct invasion by S. pyogenes or H. influenzae type b, both recognized as normal nasopharyngeal flora. With the latter, epiglottitis may arise also by direct extension, and the bacteremia may result secondarily from either the uvula or the epiglottis as a primary site of infection. Alternately, the pathogenesis of most H. influenzae type b infections is by hematogenous spread from the nasopharynx as a portal of entry.

In a review of five patients with streptococcal uvulitis, all were reported to have associated pharyngitis. The patients had low-grade fever and sore throat. Three of the five experienced a choking or gagging sensation in the pharynx, which induced coughing and spitting; one of these patients also experienced drooling. Although pharyngitis was noted on physical examination, the swelling and erythema of the uvula were most dramatic. None of the patients had evidence of respiratory distress.