Haemophilus influenzae as a cause of adult pneumonia

Haemophilus influenzae pneumonia in Melanesian adults: report of 15 cases

In a prospective study of 170 adult patients with acute pneumonia, Haemophilus influenzae was found to be the aetiological agent in 15 cases (8.8%). The diagnosis in all cases was based on positive cultures of blood or percutaneous lung aspirate, or both. Chronic lung disease was significantly more common in patients with H influenzae pneumonia than in patients with pneumonia due to other organisms but age, sex, and smoking history did not differ significantly. Lobar consolidation was the most common radiological pattern, being present in 10 of the 15 cases. Type b was the commonest serotype isolated, but three cases were due to non-typable (non-capsulate) strains. All patients survived, responding well to treatment with penicillin, ampicillin, or chloramphenicol. Haemophilus influenzae should be considered as a possible cause of pneumonia in adults, particularly those with underlying chronic lung disease.

Bacteremia due to nontypable Haemophilus influenzae--three cases in a community hospital

Nontypable Haemophilus influenzae is a normal inhabitant of the upper respiratory tract and a common pathogen in diseases limited to mucosal surfaces. Nontypable H. influenzae has only occasionally been reported to cause invasive disease locally or systemically. In a period of two years, three patients of 17 with positive blood cultures for H. influenzae were found to have nontypable strains, two of which were resistant to ampicillin. The presumed sites of entry were an oral mucosal lesion, sinus mucosa, and female genital tract. All three patients responded rapidly to antibiotics to which their isolates were susceptible.

Pneumonia and bacteremia associated with Haemophilus influenzae serotype d

Haemophilus influenzae serotype d was isolated from three women with pneumonia and underlying cardiopulmonary disease. Two of the strains were isolated from blood, and the third strain was isolated from sputum. The biotypes of the isolates were I, IV, and VI.

Transtracheal aspiration in the severely ill elderly patient with bacterial pneumonia

Transtracheal aspiration was performed in 32 elderly hypoxic patients with bacterial pneumonia. No morbidity or mortality was associated with the procedure. Gram stains of the transtracheal aspirate provided rapid, accurate delineation of the etiologic pneumonic agent, and were particularly valuable in indicating mixed bacterial infections. These included 5 cases of Streptococcus pneumoniae plus Gram-negative bacillary pneumonia. The safety and value of transtracheal aspiration in the severely ill elderly patient are discussed.

Hemophilus influenzae in hospitalized adults: current perspectives

In an eight year period 16 cases of serious extrapulmonary Hemophilus influenzae infection in adults were identified, including cases of meningitis, pericarditis, epiglottitis, empyema, cellulitis, osteomyelitis, endometritis, urinary tract infection, orbital cellulitis, primary peritonitis, mesenteric lymphadenitis and aortic graft infection. An 18 month prospective study of H. influenzae infection in hospitalized adults identified 10 cases of bronchitis, 25 of pneumonia and 65 of respiratory tract colonization, but there were no extrapulmonary infections. In 29 percent of the respiratory tract infections, H. influenzae appeared to be a nosocomial pathogen; in 71 percent, the infection was mixed. Finally, 110 clinical isolates of H. influenzae were studied for antimicrobial susceptibility. Eight percent were ampicillin resistant, two strains were resistant to tetracycline and one to chloramphenicol, but all were susceptible to trimethoprim-sulfamethoxazole and cefamandole.

Hemophilus influenzae type b pneumonia in 43 children

Using positive blood, lung, or pleural fluid cultures as definitive criteria for bacterial infection, 43 examples of Hemophilus influenzae type b pneumonia were identified in a 43-month period. The mean age of the patients was 26 months; 12% were older than 5 years of age. Associated infections were found in 34 patients and included upper respiratory infections, otitis media, epiglottitis, and meningitis. Positive nasopharyngeal cultures were observed in only 33%. Radiologically, segmental or lobar infiltrates accounted for 85% of the pneumonias. In two cases, death was attributed to the pneumonia alone. Treatment with penicillin G or ampicillin was equally effective. Our data suggest that H. influenzae pneumonia is commonly a serious infection that cannot be distinguished clinically or radiologically from other pneumonias.

Hemophilus influenzae pneumonia in adults

Hemophilus influenzae pneumonia was diagnosed in 41 adult patients based on cultures of blood, pleural fluid or transtracheal aspirate. Bacteremia occurred in all age groups, but was most frequent in patients over the age of 50 years with severe underlying pulmonary disease. Chest films usually demonstrated multisegmental or multilobar infiltrates without evidence of cavitation. Pleural involvement was evident in half of the patients, although empyema occurred infrequently. Mortality was almost always associated with serious underlying diseases and bacteremia. Encapsulated strains of H. influenzae (usually type B) were identified in 18 of 22 (82 per cent) patients. The use of transtracheal aspirations and the adoption of routine subculturing of blood cultures on chocolate agar appear to be important factors in our increased recognition of this disease.

Bacteremic hemophilus influenzae pneumonia in adults. A report of 24 cases and a review of the literature

Twenty-four cases of Hemophilus influenzae pneumonia diagnosed by positive blood or pleural fluid cultures are compared to 43 cases previously reported in the literatrue. Frequently associated illnesses in both series include alcoholism, chronic airways obstruction and preceding respiratory tract infection. Moderate temperature elevation and slight leukocytosis were common on admission in both groups. Chest roentgenograms in our series revealed both bronchopneumonia (75 per cent) and lobar consolidation (38 per cent). Pleural disease occurred frequently, with two empyemas noted on admission and nine additional effusions developing during therapy. Treatment of choice was ampicillin. All five patients who did not receive ampicillin died, whereas 16 to 19 who received this drug survived. High mortality (33 per cent) in our series may be attributed to the advanced age of the patients and the presence of associated illnesses. In addition, a 10 year review suggests a true increase in the incidence of H. influenzae pneumonia in adults.

Haemophilus influenzae type B resistant to tetracycline isolated from children with meningitis

During a three-year-period, 1971-73 inclusive, haemophili isolated from 96 children with severe infections, of whom 73 had meningitis and 19 acute epiglottitis, were serotyped and tested for sensitivity to antibacterial drugs. All strains were identified as Haemophilus influezae type b, and were sensitive to ampicillin, chloramphenicol, and trimethoprim. However, 3 isolates--from a boy aged 11 months and a girl aged 1 year with meningitis, and a girl aged 2 years with epiglottitis--were highly resistant to tetracycline, with a median minimal inhibitory concentration of 50 mug tetracycline hydrochloride per ml (resistance ratio greater than or equal to 50). Resistance was also demonstrated to doxycycline, oxytetracycline, and rolitetracycline and, in one strain, to minocycline. No evidence was obtained that the resistant organisms were capable of inactivating tetracyclines.