Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Haemophilus Influenzae Infections Workup

  • Author: Vidya R Devarajan, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: Feb 16, 2016
 

Laboratory Studies

Gram stain

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.

Bacterial culture

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.[9]

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.

Immunologic studies

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.

CSF features

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.

Next

Imaging Studies

CT scanning

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.

Chest radiography

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.

Echocardiography

Obtain this when pericarditis is suspected.

Previous
Next

Other Tests

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.

Previous
Next

Procedures

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:

  • Bronchoscopy
  • Joint, lung, sinus, and soft-tissue aspiration
  • Transtracheal aspiration
  • Tympanocentesis
  • Pericardiocentesis

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.

Previous
 
 
Contributor Information and Disclosures
Author

Vidya R Devarajan, MD 

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Wesley W Emmons, MD, FACP Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE

Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

References
  1. Ward JI, Kenneth MZ. Haemophilus influenzae. Feigin RD, Cherry JD, Fletcher J, eds. Textbook of Pediatric Infectious Diseases. 4th ed. Philadelphia, Pa: WB Saunders and Co; 1998. 1464-1482.

  2. Watt JP, Wolfson LJ, O'Brien KL, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet. 2009 Sep 12. 374(9693):903-11. [Medline].

  3. Jacups SP. The continuing role of Haemophilus influenzae type b carriage surveillance as a mechanism for early detection of invasive disease activity. Hum Vaccin. 2011 Dec 1. 7(12):[Medline].

  4. Active Bacterial Core Surveillance Report, Emerging Infections Program Network Haemophilus Influenzae, 2006. Available at www.cdc.gov/ncidod/dbmd/abcs/survreports.hib.pdf.

  5. Jin Z, Romero-Steiner S, Carlone GM, et al. Haemophilus influenzae type a infection and its prevention. Infect Immun. 2007 Jun. 75(6):2650-4. [Medline].

  6. MacNeil JR, Cohn AC, Farley M, Mair R, Baumbach J, Bennett N, et al. Current epidemiology and trends in invasive Haemophilus influenzae disease--United States, 1989-2008. Clin Infect Dis. 2011 Dec. 53(12):1230-6. [Medline].

  7. von Gottberg A, Cohen C, Whitelaw A, Chhagan M, Flannery B, Cohen AL, et al. Invasive disease due to Haemophilus influenzae serotype b ten years after routine vaccination, South Africa, 2003-2009. Vaccine. 2011 Nov 26. [Medline].

  8. Haemophilus Influenzae serotype b (Hib) disease. Available at www.cdc.gov/ncidod/dbmb/diseaseinfo/haeminfluserob_t.htm. Accessed: Feb 15, 2008.

  9. Roush SW, Murphy TV. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. 2007 Nov 14. 298(18):2155-63. [Medline].

  10. Singleton R, Hammitt L, Hennessy T, et al. The Alaska Haemophilus influenzae type b experience: lessons in controlling a vaccine-preventable disease. Pediatrics. 2006 Aug. 118(2):e421-9. [Medline].

  11. Satola SW, Collins JT, Napier R, et al. Capsule gene analysis of invasive Haemophilus influenzae: accuracy of serotyping and prevalence of IS1016 among nontypeable isolates. J Clin Microbiol. 2007 Oct. 45(10):3230-8. [Medline].

  12. Scarborough M, Gordon SB, Whitty CJ, et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. N Engl J Med. 2007 Dec 13. 357(24):2441-50. [Medline].

  13. van de Beek D, de Gans J, McIntyre P, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2007. (1):CD004405. [Medline].

  14. McIntyre PB, Berkey CS, King SM, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta- analysis of randomized clinical trials since 1988. JAMA. 1997 Sep 17. 278(11):925-31. [Medline].

  15. [Guideline] Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1. 39(9):1267-84. [Medline].

  16. Syrogiannopoulos GA, Lourida AN, Theodoridou MC, et al. Dexamethasone therapy for bacterial meningitis in children: 2- versus 4-day regimen. J Infect Dis. 1994 Apr. 169(4):853-8. [Medline].

  17. Peltola H, Roine I, Fernandez J, et al. Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2007 Nov 15. 45(10):1277-86. [Medline].

  18. Bridges CB, Coyne-Beasley T, on behalf of the Advisory Committee on Immunization Practices. Advisory Committee on Immunization Practices recommended immunization schedule for adults aged 19 years or older - United States, 2014. Ann Intern Med. 2014;160(3):190-7. Available at http://annals.org/article.aspx?articleid=1819123.

  19. Lowry F. ACIP issues 2014 immunization schedule for adults. Medscape Medical News. February 3, 2014. Available at http://www.medscape.com/viewarticle/820145. Accessed: February 10, 2014.

  20. American Academy of Pediatrics. Red Book 2006: The Report of the Committee on Infectious Disease. American Academy of Pediatrics. Haemophilus infulenzae infections. 27th ed. 2006. 310-318, 89.

  21. American Academy of Pediatrics Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedule: United States, 2005. Pediatrics. 2005 Jan. 115(1):182. [Medline].

  22. Andrade AL, Martelli CM. Globalisation of Hib vaccination--how far are we?. Lancet. 2005 Jan 1-7. 365(9453):5-7. [Medline].

  23. Barthel D, Singh B, Riesbeck K, Zipfel PF. Haemophilus influenzae Uses the Surface Protein E To Acquire Human Plasminogen and To Evade Innate Immunity. J Immunol. 2012 Jan 1. 188(1):379-85. [Medline].

  24. Bozdogan B, Appelbaum PC. Macrolide resistance in Streptococci and Haemophilus influenzae. Clin Lab Med. 2004 Jun. 24(2):455-75. [Medline].

  25. Centers for Disease Control and Prevention. Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommendations for use of Hib vaccine. MMWR Morb Mortal Wkly Rep. 2009 Sep 18. 58(36):1008-9. [Medline].

  26. Centers for Disease Control and Prevention. Progress toward elimination of Haemophilus influenzae type b invasive disease among infants and children--United States, 1998-2000. MMWR Morb Mortal Wkly Rep. 2002 Mar 22. 51(11):234-7. [Medline].

  27. Centers for Disease Control and Prevention. Updated recommendations for use of Haemophilus influenzae type b (Hib) vaccine: reinstatement of the booster dose at ages 12-15 months. MMWR Morb Mortal Wkly Rep. 2009 Jun 26. 58(24):673-4. [Medline].

  28. Claesson BA, Trollfors B, Lagergard T, et al. Antibodies against Haemophilus influenzae type b capsular polysaccharide and tetanus toxoid before and after a booster dose of the carrier protein nine years after primary vaccination with a protein conjugate vaccine. Pediatr Infect Dis J. 2005 May. 24(5):463-4. [Medline].

  29. Cunha BA. Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, Michigan: Physicians Press; 2008.

  30. Daum R. Haemophilus influenzae. Behrman RE, Kliegman R, eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders and Co; 2000. 833-837.

  31. Daza P, Banda R, Misoya K, et al. The impact of routine infant immunization with Haemophilus influenzae type b conjugate vaccine in Malawi, a country with high human immunodeficiency virus prevalence. Vaccine. 2006 Sep 11. 24(37-39):6232-9. [Medline].

  32. de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002 Nov 14. 347(20):1549-56. [Medline].

  33. Fickweiler K, Borte M, Fasshauer M, et al. Meningitis due to Haemophilus influenzae type f in an 8-year-old girl with congenital humoral immunodeficiency. Infection. 2004 Apr. 32(2):112-5. [Medline].

  34. Gallaher TK, Wu S, Webster P, et al. Identification of biofilm proteins in non-typeable Haemophilus Influenzae. BMC Microbiol. 2006. 6:65. [Medline].

  35. Garner D, Weston V. Effectiveness of vaccination for Haemophilus influenzae type b. Lancet. 2003 Feb 1. 361(9355):395-6. [Medline].

  36. Gessner BD, Sutanto A, Linehan M, et al. Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial. Lancet. 2005 Jan 1-7. 365(9453):43-52. [Medline].

  37. Gold R. Epidemiology of bacterial meningitis. Infect Dis Clin North Am. 1999 Sep. 13(3):515-25, v. [Medline].

  38. Hall-Stoodley L, Hu FZ, Gieseke A, et al. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA. 2006 Jul 12. 296(2):202-11. [Medline].

  39. Kelly DF, Moxon ER, Pollard AJ. Haemophilus influenzae type b conjugate vaccines. Immunology. 2004 Oct. 113(2):163-74. [Medline].

  40. Leibovitz E, Jacobs MR, Dagan R. Haemophilus influenzae: a significant pathogen in acute otitis media. Pediatr Infect Dis J. 2004 Dec. 23(12):1142-52. [Medline].

  41. McVernon J, Trotter CL, Slack MP, et al. Trends in Haemophilus influenzae type b infections in adults in England and Wales: surveillance study. BMJ. 2004 Sep 18. 329(7467):655-8. [Medline].

  42. Mitchell V, Walker D, Zuber P, et al. Evidenced-based decision making about Hib vaccination. Lancet. 2005 Mar 12-18. 365(9463):936-7. [Medline].

  43. Moxon ER, Murphy TF. Haemophilus influenzae. Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 5th ed. New York, NY: Churchill Livingstone; 2000. 2369-2378.

  44. Murphy TF, Kasper DT. Infections due to Haemophilus influenzae, other Haemophilus species, the HACEK group, and other gram-negative bacilli. Braunwald E, Fauci AS, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998. 924-928.

  45. Nguyen TH, Tran TH, Thwaites G, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med. 2007 Dec 13. 357(24):2431-40. [Medline].

  46. Peltola H, Salo E, Saxén H. Incidence of Haemophilus influenzae type b meningitis during 18 years of vaccine use: observational study using routine hospital data. BMJ. 2005 Jan 1. 330(7481):18-9. [Medline]. [Full Text].

  47. Rudan I, Campbell H. The deadly toll of S pneumoniae and H influenzae type b. Lancet. 2009 Sep 12. 374(9693):854-6. [Medline].

  48. Scheifele D, Halperin S, Law B, et al. Invasive Haemophilus influenzae type b infections in vaccinated and unvaccinated children in Canada, 2001-2003. CMAJ. 2005 Jan 4. 172(1):53-6. [Medline]. [Full Text].

  49. Starner TD, Zhang N, Kim G, et al. Haemophilus influenzae forms biofilms on airway epithelia: implications in cystic fibrosis. Am J Respir Crit Care Med. 2006 Jul 15. 174(2):213-20. [Medline].

  50. Steinhoff M, Goldblatt D. Conjugate Hib vaccines. Lancet. 2003 Feb 1. 361(9355):360-1. [Medline].

  51. Strausbaugh LJ. Haemophilus influenzae infections in adults: a pathogen in search of respect. Postgrad Med. 1997 Feb. 101(2):191-2, 195-6, 199-200. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.