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Haemophilus sp cause numerous
mild and serious infections, including bacteremia, meningitis, pneumonia,
otitis media, cellulitis, and epiglottitis. Diagnosis is by culture and
serotyping. Treatment is with antibiotics.
There are several pathogenic species of Haemophilus, the most common of which is H. influenzae, which has 6 distinct encapsulated strains, a through f, and numerous nonencapsulated, nontypeable strains. Before the use of H. influenzae type b (Hib) conjugate vaccine, most cases of serious, invasive disease were caused by type b. H. influenzae causes many childhood infections, including meningitis, bacteremia, septic arthritis, pneumonia, tracheobronchitis, otitis media, conjunctivitis, sinusitis, and acute epiglottitis. These infections, as well as endocarditis, may occur in adults, although far less commonly. These illnesses are discussed elsewhere in The Manual. Occasionally, nonencapsulated strains cause invasive infections.
H.
influenzae serotype aegyptius may cause mucopurulent conjunctivitis and bacteremic Brazilian purpuric fever. H. ducreyi causes chancroid (see Sexually Transmitted Diseases (STD): Chancroid). H. parainfluenzae and H. aphrophilus are rare causes of bacteremia, endocarditis, and brain abscess.
Many Haemophilus sp are normal flora in the upper respiratory tract and rarely cause illness. Pathogenic strains enter the upper respiratory tract through droplet inhalation or direct contact. Spread is rapid in nonimmune populations. Children are at highest risk of serious infection, particularly males, blacks, and Native Americans. Overcrowded living conditions and day care center attendance predispose to infection, as do immunodeficiency states, asplenia, and sickle cell disease.
Diagnosis
and Treatment
Diagnosis is by culture of blood and body fluids. Strains involved with invasive illness should be serotyped.
Treatment depends on nature and location of the infection, but doxycycline , fluoroquinolones, 2nd- and 3rd-generation cephalosporins, and carbapenems are used for invasive disease. The Hib vaccine has markedly reduced the rate of bacteremia. Children with serious illness are hospitalized with contact and respiratory isolation for 24 h after starting antibiotics. Antibiotic choices depend strongly on the site of infection and require sensitivity testing; many isolates in the US produce β-lactamase. For invasive illness, including meningitis, cefotaxime or ceftriaxone is recommended. For less serious infections, oral cephalosporins, macrolides, and amoxicillin-clavulanate are generally effective. (See individual disease entries for specific recommendations.)
Prevention
Hib conjugate vaccines are available for children ≥ 2 mo of age and have reduced invasive infections such as meningitis, epiglottitis, and bacteremia by 99%. A primary series is given at 2, 4, and 6 mo or 2 and 4 mo, depending on the vaccine product. A booster at 12 to 15 mo is indicated.
Contacts within the household may have asymptomatic H. influenzae carriage. Unimmunized or incompletely immunized household contacts < 4 yr are at risk for illness and should receive a dose of vaccine. In addition, all household members (except pregnant women) should receive prophylaxis with rifampin 600 mg (20 mg/kg for children) po once/day for 4 days. Nursery or day care contacts should receive prophylaxis if ≥ 2 cases of invasive disease occurred in 60 days. The benefit of prophylaxis if only one case occurred has not been established.
Last full review/revision November 2005
Content last modified November 2005
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