Pediatric Haemophilus Influenzae Infection Treatment & Management

  • Author: Mobeen H Rathore, MD, CPE, FAAP, FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 8, 2010
 

Medical Care

Medical care depends on the disease syndrome. Children with invasive Haemophilus influenzae disease require careful attention and, often, intensive care. Medical care depends on the organ system or problems involved, as follows:

  • CNS: Lumbar puncture should be considered in a child with invasive H influenzae type b (Hib) disease. Complications, including subdural effusion, ventriculitis, infarction, abscess, sensorineural deafness, and developmental delay, must be considered.
  • Neonatal disease: Routine therapy with ampicillin and gentamicin for presumptive neonatal sepsis may not be effective if an ampicillin-resistant strain of Hib is the cause of the infection.
  • Meningitis: Prompt use of intravenous antibiotics and good supportive care are the mainstays of therapy.
  • Fluid and electrolyte disturbances: Seizures may be due to hyponatremia as a result of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The fluid status must be closely monitored in children with Hib meningitis, and the use of fluids, particularly hypo-osmolar fluids, on an ad-lib basis is contraindicated.
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Surgical Care

Consultation with a surgeon may be required in some children with invasive Hib disease. Procedures that may be necessary include the following:

  • Tracheotomy - For Hib epiglottitis when the airway cannot be managed with endotracheal intubation
  • Arthrocentesis or bone debridement - For osteomyelitis or septic arthritis, particularly involving the hip
  • Neurosurgery - For subdural empyema complicating meningitis or intracranial complications of orbital cellulitis[3]
  • Surgical drainage - For septic arthritis of the hip joint
  • Open drainage - For most cases of septic arthritis of the shoulder
  • Early pericardectomy - For pericarditis; the treatment of choice, used in conjunction with antibiotics
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Consultations

Depending on the manifestations of invasive H influenzae disease, consultants required may include neurologists, neurosurgeons, orthopedic surgeons, anesthesiologists, critical care physicians, and infectious diseases physicians. An audiologist should evaluate all children after they receive treatment for H influenzae meningitis.

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Contributor Information and Disclosures
Author

Mobeen H Rathore, MD, CPE, FAAP, FIDSA  Chief of Division of Pediatric Infectious Diseases/Immunology, Associate Chairman of Department of Pediatrics, University of Florida College of Medicine at Jacksonville; Hospital Epidemiologist and Section Chief of Infectious Disease and Immunology, Wolfson Children's Hospital; Director of University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)

Mobeen H Rathore, MD, CPE, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, European Society for Paediatric Infectious Diseases, Florida Medical Association, Florida Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America, Society for Pediatric Research, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Ayesha Mirza, MD  Assistant Professor, Pediatric Infectious Diseases, University of Florida College of Medicine Jacksonville

Ayesha Mirza, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, HIV Medicine Association of America, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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  2. Friesen CA, Cho CT. Characteristic features of neonatal sepsis due to Haemophilus influenzae. Rev Infect Dis. 1977;8:777. [Medline].

  3. Lessner A, Stern GA. Preseptal and orbital cellulitis. Infect Dis Clin North Am. Dec 1992;6(4):933-52. [Medline].

  4. Kroger AT, Atkinson WL, Marcuse EK, Pickering LK. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Dec 1 2006;55:1-48. [Medline]. [Full Text].

  5. Ward J, Lieberman JM, Cochi S. Haemophilus influenzae vaccines. In: Plotkin S, Mortimer E, eds. Vaccines. 1994:337.

  6. [Best Evidence] [Guideline] CDC. Licensure of a Haemophilus influenzae type b (Hib) vaccine (Hiberix) and updated recommnedations for use of Hib vaccine. MMWR. 2009;58:1008-1009. [Medline]. [Full Text].

  7. [Best Evidence] CDC. Invasive Haemophilus influenzae type b disease in five young children--Minnesota, 2008. MMWR. January 2009;58:58-60. [Medline]. [Full Text].

  8. Dajani AS, Asmar BI, Thirumoorthi MC. Systemic Haemophilus influenzae disease: an overview. J Pediatr. Mar 1979;94(3):355-64. [Medline].

  9. Hamlin J, Senthilnathan S, Bernstein HH. Update on universal childhood immunizations. Curr Opin Pediatr. Aug 2008;20(4):483-9. [Medline].

  10. Lebel MH, Freij BJ, Syrogiannopoulos GA, et al. Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. N Engl J Med. Oct 13 1988;319(15):964-71. [Medline].

  11. Murphy TF, Apicella MA. Nontypable Haemophilus influenzae: a review of clinical aspects, surface antigens, and the human immune response to infection. Rev Infect Dis. Jan-Feb 1987;9(1):1-15. [Medline].

  12. Rubin LG, Moxon ER. Pathogenesis of bloodstream invasion with Haemophilus influenzae type b. Infect Immun. Jul 1983;41(1):280-4. [Medline].

  13. Shapiro ED, Ward JI. The epidemiology and prevention of disease caused by Haemophilus influenzae type b. Epidemiol Rev. 1991;13:113-42. [Medline].

  14. St Geme JW. The pathogenesis of nontypable Haemophilus influenzae otitis media. Vaccine. 2000;8; Suppl 1:S41-50. [Medline].

 
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