Haemophilus Influenzae Infection

Although Haemophilus influenzae can affect many organ systems, it most frequently attacks the respiratory system. It's a common cause of epiglottitis, laryngotracheobronchitis, pneumonia, bronchiolitis, otitis media, and meningitis. Less often, it causes bacterial endocarditis, conjunctivitis, facial cellulitis, septic arthritis, and osteomyelitis.

H. influenzae type B (Hib) infection predominantly affects children, at a rate of 3% to 5%. This incidence was higher before vaccinations were used in day-care centers. The vaccine is administered at ages 2, 4, 6, and 15 months. The incidence of meningitis in black children is higher due to Hib. In Native Americans, the incidence of the disease is 10 times higher, possibly due to exposure, socioeconomic conditions, and genetic differences in immune response.

Causes

Hib disease is caused by Haemophilus influenzae serotype b, a bacterium.

Hib enters the body through the nose or throat and then can spread to cause meningitis. Pneumonia, ear, skin, joint, and blood infections can also occur.

Symptoms and Signs

• Bulging of the fontanelles
• Opisthotonos
• Seizures
• Poor circulation
• Irritability, poor feeding in infants
• Fever
• Severe headache (older children)
• Nausea and vomiting
• Stiff neck or pain in neck when flexed
• Pain in back when neck is flexed foreward and chin brought toward chest (older children)
• Sensitivity to light

Diagnostic tests

Isolation of the organism, usually with a blood culture, confirms H. influenzae infection. Hib meningitis is detectable in cerebrospinal fluid cultures. A positive nasopharyngeal culture isn't diagnostic because this may be a normal finding in healthy people.

Treatment

H. influenzae type B infections may be rapidly fatal without prompt, effective treatment. Patients with meningitis due to Hib are treated with cefotaxime or ceftriaxone. As an alternative, doctors may prescribe a combination of chloramphenicol and ampicillin. Glucocorticoids can reduce neurologic sequelae. Airway maintenance is critical in epiglottitis.

Prevention

• Several types of Hib vaccine are available for children that are at least 2 months old.
• Hib immunizations for infants and children are recommended by the American Academy of Pediatrics, the National Institutes of Health, and many other health agencies.

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