Haemophilus influenzae
| Categorization | |
|---|---|
| Cell Wall: Gram Negative | Shape: Coccoid Rod |
| Metabolism: Facultative Anaerobe | |
| Culture and Detection |
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- Selective Media for H. influenzae is a chocolate agar supplemented with Factors V (NAD) and Factor X (hemin).
| Virulence Factors |
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- Capsule
- Six serotypes of H. influenzae possess an antiphagocytic polysaccharide capsule and are identified by letters a through f. These strains are highly invasive and can disseminate systemically with the Type b strain being the most dangerous. Several strains lack capsule and are termed "Non-typable". These are only locally invasive and can only disseminate to structures contiguous with the nasopharynx.
| Transmission |
|---|
- H. influenzae is transmitted by aerosolized droplets. Non-typable trains are part of the normal nasopharyngeal flora in many individuals.
| Clinical Consequences |
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- Typable Strains (Especially Type b)
- Typable strains of H. influenzae (especially Type b) invade through the nasopharyngeal mucosa, gain access to the blood stream, and can spread to distant sites
- Meningitis: Usually affects infants less than 2yo
- Acute Epiglottitis: Usually affects children less than 6yo and results in a characteristic "Cherry red" epiglottis which can be life-threatening due to potential airway obstruction]
- Septic Arthritis: Usually occurs only in children <6yo
- Community-acquired Pneumonia: Usually occurs in infants
- Non-typable Strains
- Non-typable strains of H. influenzae are only locally invasive and generally cause disease only in adults with reduced immunity or superficial ear infections in the young
- Community-acquired Pneumonia: Non-typable strains are a frequent cause of Pneumonia especially in those with COPD
- Otitis Media: H. influnzae is the most common cause of Otitis Media in infants
| Immunity |
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- Protective immunity to Typable strains of H. influenzae is through humoral immunity which develops antibodies to the polysaccharide capsule. The predilection of Type b infections in infants between 6mo - 2yo is due to an antibody window.
| Prevention |
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- A conjugate vaccine is available for the Type b serotype and is frequently administered to infants. It consists of the Type b capsular polysaccharide fused to diphtheria toxin.
| Treatment |
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- First Choices
- Typable strains: Third Generation Cephalosporins such as cefotaxime and ceftriaxone
- Non-typable strains: Amoxicillin
- Additional Choices
- Ciprofloxacin or Bactrim