Haemophilus Influenzae Infections Workup
- Author: Vidya R Devarajan, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more...
Test results on body fluids from various sites of infection that reveal small, gram-negative, pleomorphic coccobacilli with polymorphonuclear cells are strong evidence of infection.
Detection of the organism in a blood culture or any other body fluid is the most confirmatory method of establishing the diagnosis.
Slide agglutination with type-specific antisera is used for serotyping H influenzae. In one study, molecular typing with PCR was found to be more accurate than slide agglutination serotyping.
Seventy to 90% of patients with epiglottitis have positive blood culture results. However, to avoid laryngospasm, perform venipuncture and cultures of the inflamed epiglottitis only after the airway has been secured.
Detection of the PRP polysaccharide capsule via countercurrent immunoelectrophoresis, latex particle agglutination, co-agglutination, and enzyme-linked immunosorbent assay is an important adjunct to culturing in establishing a rapid diagnosis.
Even if antibiotics were previously administered, the diagnosis can be confirmed based on the detection of the polysaccharide capsule in body fluids, including serum, CSF, urine, and pleural, pericardial, and articular fluid. False-positive results in CSF are rare but occur with serum or urine because of nonspecific agglutination and antigenic cross-reactivity with other bacteria.
In meningitis, the CSF examination demonstrates pleocytosis (mean, 4000-5000 WBCs/µL) with a predominance of neutrophils.
Decreased CSF glucose levels are encountered in 75% of patients, increased CSF protein levels and detectable capsular antigen in 90%, and a positive CSF Gram stain result in 80%.
Prior antibiotic treatment significantly decreases the H influenzae type b (Hib) concentration in the CSF and decreases the sensitivity of the Gram stain; however, antibiotics do not substantially affect the total CSF blood cell count, differential, chemistries, and presence of the PRP capsule in pretreated patients.
Blood cell counts
Perform blood cell counts for anemia, leukocytosis, and thrombocytosis or thrombocytopenia.
Acute phase reactants
Elevated erythrocyte sedimentation rates (ESRs) and C-reactive protein levels are characteristically observed in patients with septic arthritis.
In meningitis, a CT scan of the head is not required routinely unless focal neurologic findings are present or clinical response is lacking after 3 days' administration of appropriate antibiotics. In these situations, a head CT scan helps identify subdural effusion.
In patients with orbital cellulitis, a CT scan of the head is useful in delineating the extent of the lesion.
Patients with Hib pneumonias tend to have more pleural and pericardial involvement (50% of patients) than those with other bacterial pneumonias.
Community-acquired pneumonias due to NTHi are characterized by alveolar infiltrates in patchy or lobar distributions.
Lateral neck radiography
In epiglottitis, a lateral neck radiograph reveals dilatation of the hypopharynx and a swollen epiglottis (termed the thumbprint sign). In addition, the cervical spine is usually straightened.
If epiglottitis is clinically suspected, obtain radiography only if a functional airway is guaranteed.
Obtain this when pericarditis is suspected.
In patients with cellulitis, direct aspiration of the soft tissue or aspiration after injecting the subcutaneous tissue with sterile nonbacteriostatic solution can be used to detect the organisms via Gram stain and culture.
Perform a lumbar puncture when meningitis is suspected.
The following invasive procedures can be used to obtain appropriate fluid and to establish an etiologic diagnosis:
Joint, lung, sinus, and soft-tissue aspiration
In women, obtain tubal cultures via laparoscopy and peritoneal fluid cultures by culdocentesis for NTHi.
In patients with epiglottitis, use endotracheal intubation or tracheostomy to secure an airway.
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