Haemophilus influenzae ( Hib - infection) - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

Haemophilus influenzae (Hib - infection) - a group of acute infectious disease caused by a stick Pfeiffer (left), with the airborne mechanism of infection that affects mainly children's age group and is characterized by inflammation of the respiratory system, central nervous system with the possible formation of purulent lesions invarious tissues and organs (sepsis).

Haemophilus influenzae - a very common disease in the pediatric age group.The incidence of Hib infection is high, but statistically it is difficult to fully calculate.One reason is the bad check, because clinically ARI Haemophilus origin is not very different from, for example, pneumococcal or staphylococcal infections.Therefore, it can be considered only with the development of severe cases of pneumonia, meningitis and other manifestations.

Possibility healthy carrier with Haemophilus influenzae causes concern because it is uncontrollable from an epidemiological point of view of the process.In some countries, the frequency carriers in th

e pre-school teams reaches 40%, which explains the high incidence of acute respiratory infections in kindergartens.However, the presence of specific preventive maintenance saves the situation up to the reduction of morbidity in the form of individual cases in a number of European countries.For example, in the UK the introduction of routine vaccination reduced the incidence of up to 1-2 cases per year.In our country the free vaccine was introduced in the national immunization schedule only for certain categories of children (oncology, HIV, immunodeficiency, as well as children of children's homes), so vaccination company remaining children is exclusively on the initiative of parents and only depends on their awareness of the issue.

The pathogen Haemophilus influenzae

Pathogen - Haemophilus influenzae Afanasyeva-Pfeiffer (Haemophilus influenzae) type B (Hib hence the name).Now allocate about 16 species of Haemophilus influenzae and 6 antigenically different types (a to f), but the most pathogenic for humans is exactly the type B. This gram "-" micro-organism (for Gram staining and microscopy are not painted) very small size(1 micron diameter) that can be converted into the S-shape (forming a protective polysaccharide capsule).It is this capsule allows hemophilic stick to survive long in the human body, evading the immune system, as well as from the action of antibacterial drugs."Thanks" to the capsule body of the child for a long time can not generated protective antibody or produced in small quantities, so the kids can get sick this infection repeatedly.Haemophilus influenzae - a conditional pathogen is often representative of normal human airway mucosal microflora, so the high frequency of healthy carriers of the pathogen.

Haemophilus influenzae after Gram stain

Reasons spread

Hib source of infection is the patient symptomatic form of the disease (from ARI to pneumonia, meningitis and sepsis).Also, the source of infection are healthy carriers of Hib.The focus of Hib carriage rate may reach 70% of children and 30-40% of adults.

mechanism infection - aerogenic and path - airborne (pathogen spread is by sneezing, coughing, talking with mucus of the bronchial tree - phlegm and mucus rotor and nasopharynx).The greatest chance of infection in people who are in close proximity to the source of infection (3 meters or less).The patient becomes contagious with onset of illness.Media outwardly healthy, therefore, epidemiological side of the most dangerous, but such people emit less infectious types of Haemophilus influenzae.Additional route of infection - contact-household (through household items - towels, dishes, toys).

Season with this infection - winter-spring.Susceptibility to infection high among young children - from 6 months to 2 and sometimes 4 years.Up to 6 months due to "maternal protection" children rarely get sick.Older than 5-years and adults suffer in individual cases.

risk for susceptibility to Haemophilus influenzae:

1) The age group of children from 6 months to 2 years.
2) Persons older than 65 years.
3) Children who are bottle-fed.
4) Immunodeficiencies (cancer, blood disease, HIV infection, and others.).
5) Persons after the removal of the spleen.
6) Social immunodeficiency (alcoholism, drug addiction).
7) Children from closed institutions (children's homes, orphanages).

Way Pfeiffer bacillus in the human body:

entrance gate of infection - the mucous membrane of the nasopharynx, where the pathogen may be a long time.Further development of the process depends largely on the local mucosal resistance (reduced resistance to colds can cause frequent infections, hypothermia, stress).If there is a weak resistance breeding sticks, its accumulation and penetration in the blood (bacteremia).And then the infection spreads favorite organs and tissues (lungs, sinuses, skeletal system, central nervous system, etc.) with the possibility of sepsis (multiple purulent foci).

Symptoms of Hib

incubation period (from the time of infection until the first symptoms of the disease) to identify virtually impossible, because the Haemophilus influenzae may be a long time to be on the nasopharyngeal mucosa without causing any changes (asymptomatic) and only with a decrease in the protective forces begins to multiply.

Start infection can be similar to acute respiratory illness (ARI), then comes the generalization of the process (bacillus enters the bloodstream and spreads throughout the body), and there is one of the clinical forms.

identifies several typical forms of Haemophilus influenzae:

1) The purulent meningitis (inflammation of the pia mater)
2) Acute pneumonia (pneumonia)
3) Sepsis, in particular one of its forms - septicemia (systemic disease)
4)Cellulite or cellulitis (inflammation of the subcutaneous tissue)
5) Epiglottitis (epiglottis defeat)
6) Acute arthritis (joint disease)
7) Rarer forms (otitis, sinusitis, pericarditis, destruction of the respiratory tract, etc.).

purulent meningitis Hib etiology is the most common cause of meningitis in the pediatric age group of 6 months to 4 years.The younger the age of the patient, the disease is more severe.The percentage of neurological complications is high - up to 40% mortality rate slightly more than 10%.Symptoms combined into three syndromes:
- infectious-toxic syndrome (feature is the gradual onset with acute respiratory infections, high temperature up to 38-39 ° and more individuals and redness of the neck);
- cerebral symptoms (pronounced headaches, nausea, vomiting, often repeated, increased sensitivity to all kinds of stimuli);
- meningeal syndrome (neck stiffness - the inability of the passive flexion of the head in the supine position, Kernig symptoms Brudzinskogo).Current haemophilus meningitis long, wavy.

especially in infants:

1) Equivalent headache - "brain cry" - long-lasting, even permanent piercing cry baby, like vysokotembralny howl.
2) Due to severe hypersensitivity can not be determined meningeal signs of the skin.Helps Lessazha symptom (when hanging baby armpits kids draw in first leg, and then do not straighten them as healthy and keep loosing contact state for a long time).
3) Due to the high temperature of the high risk of seizures.
4) Children of the first year of life will fall into unconsciousness.
5) large bulging fontanelle (on top of the child).The smaller the size of a large fontanelle, the faster may occur loss of consciousness.
6) Equivalent vomiting - regurgitation.
7) indication for lumbar puncture is high fever with no other symptoms and shrill cry baby.
Cerebrospinal fluid at lumbar puncture follows pressure (often drops), muddy, greenish, pleocytosis or increased cellular composition of cerebrospinal fluid in the hundreds in 1 mm, is dominated by neutrophils.

At persistent symptoms persist, meningitis and convulsions accession, the second wave of fever, psycho-motor excitation of the patient to think about joining ventriculitis (inflammation of the brain ventricles), and subdural suppuration.

What must make to see a doctor? Persistent high fever, headache, or constant crying baby, vomiting or regurgitation, muscle twitching.No need to wait, immediately call an ambulance.

acute pneumonia. One of the common causes of pneumonia in children is Haemophilus influenzae.Pneumonia can be focal or lobar (affecting lung lobe or multiple lobes), it is often complicated by pleurisy (inflammation of the pleura - lung membranes) - up to 70% of cases in children.The patient has a high fever, weakness, lethargy, cough at first dry and unproductive, and then becomes wet (purulent sputum with a yellowish tinge).Often, violations of respiratory excursion, which is manifested by shortness of breath.Current pneumonia prolonged, difficult to treat, can be wavy.

Haemophilus pneumonia

To the doctor make contact: high fever, the child's listlessness, refusal to eat, lethargy, regurgitation, cough and vomiting.

Septicaemia - a systemic disease caused by Haemophilus influenzae penetration into the blood, which has a variety of clinical manifestations.Most hemophilic sepsis occurs among children 6-12 months.It flows as a gram "-" sepsis - without the occurrence of secondary septic foci, hard, even immediately.High probability of septic shock and death.
is characterized by high fever (up to 40 °), enlarged spleen, a rapid hemodynamic impairment (drop in blood pressure, increased heart rate), there are microcirculatory disorders (bleeding in the skin of the trunk, limbs, face).The mortality rate is high.

hemophilic sepsis

What cause to see a doctor? Fever, lethargy child's refusal to eat, lethargy, pale skin, blue lips, rapid heartbeat, the appearance of hemorrhages in the skin from small to large, reduction in the frequency of urination.Urgent call an ambulance.

Cellulite is more common in children under one year.Against the background of the picture appears ARI swelling in the affected area (usually the face, limbs less).In the lesion area of ​​red skin with a bluish tinge, swelling, tenderness to palpation.Sometimes it may be accompanied by other symptoms (e.g., otitis media - otitis).The temperature in most cases small (37-37,5 °).

hemophilic orbital cellulitis

Epiglottitis mainly occurs in children from 2 to 4-5 years of age and is characterized by severe.Against the background of high temperature there is a strong pain in the throat, trouble swallowing, breathing disorders on the reasons for the narrowing of the larynx in the inflamed epiglottis.Patient speech disorder (dysphonia), pale skin, excessive salivation, throwing the head back.On examination of the throat and pressing with a spatula on the root of the tongue can be seen bright red epiglottis.At laryngoscopy - an inflammation of the epiglottis, swelling in the subglottic space.If time does not help, it is possible complete blockage of the larynx in the field of inflammation up to loss of consciousness and death.The patient was urgently required intubation or tracheostomy.

To the doctor ask for: occurrence of severe pain in the throat and tilting the child's head, dyspnea on this background, it is impossible to swallow a sip of water and say the word, high temperature.

Acute arthritis - rarely isolated.Against the background of acute respiratory failure appears one or more joints of the extremities.Sometimes arthritis complicated by inflammation of the bone (osteomyelitis).

Complications Hib

- cerebral edema due to the development of Haemophilus meningitis syndrome herniation of the cerebellar tonsils into the foramen magnum, and death.
- Acute respiratory failure due to acute pneumonia.
- Asphyxia (airway obstruction) due to epiglottitis with the development of respiratory failure and death.
- Septic shock due to septicemia with the development of hemodynamic disorders, microcirculation and death.

after previous infection formed a long lasting immunity.Recurrent disease can only immunoskompromentirovannyh persons.

Diagnostics Haemophilus influenzae

preliminary diagnosis is made based on the patient's age (from 6 months to 4 years mostly), typical symptoms (appearance on the background of acute respiratory infections the most common forms - meningitis, pneumonia, sepsis, etc.).The similarity of clinical symptoms with almost all bacterial infections reduces diagnostics for the early laboratory confirmation.The general analysis of blood - decrease in red blood cells (anemia), increase in white blood cells, neutrophils, ESR.

final diagnosis - after laboratory studies.Materials for the study - nasal mucus, sputum, cerebrospinal fluid, blood, pus lesions.Methods:
- bacteriological (seeding material on blood agar, chocolate agar);
- bakterioskopiesky (microscopy Gram stained preparations);
- capsular antigen detection by reacting counter immunoelectrophoresis;
- serology (agglutination reaction of latex, microprecipitation).

Treatment Haemophilus influenzae

1. Organizational-regime activities (hospitalization of children with moderate to severe forms of infection in the hospital, bed rest for the entire febrile period, proper diet with exception of highly salty foods, drinking plenty of fluids according to indications)

2. Causalantibiotic therapy (assigned to the results of laboratory research) in order to prevent serious complications of Hib.In severe drugs of choice - cephalosporins III and IV generations, carbapenems, ampicillin, aminoglycosides.In milder forms - amoxicillin, cefaclor.When resistance to chloramphenicol, ampicillin is appointed, but he was appointed less.The duration of treatment depends on the clinical forms of infection: 7 to 14 days.Only a doctor prescribed the drug.Independent home assignment can lead to disastrous consequences (complications).

3. Pathogenetic therapy is performed in a hospital and involves the restoration of the disturbed functions of vital organs and systems (detoxification infusion therapy, prevention of complications).

4. Posindromalnaya
• antipyretic therapy (Panadol, Nurofen, efferalgan, etc.);
• vasoconstrictor nose drops (akvamaris infants, nazivin, Nazol, tizin, Otrivin, etc.);
• expectorants (Lasolvan, ambroxol, gedeliks);
• cellulite and epiglotite mainstay of treatment - antibacterial therapy.

Mild forms of the disease can occur under the guise of ARI, but in any case in the future will manifest, or sinusitis, or sinusitis, or bronchitis, or otitis media.That is to see a doctor should be appointed antibiotics.If etiotrop treatment will not, in most cases, formed some clinical form of Hib that is forecast will be a worsening of the disease.

Prevention Hib

There is a specific prevention - a vaccine.In Russia registered the Act-HIB (France).The vaccine contains capsular polysaccharide of Haemophilus influenzae type b, combined with a tetanus toxoid with a view to the possibility of introducing it and develop immunity to 2hmesyachnogo age life.It requires 3hkratnoe introduction.

vaccination in children's groups can significantly reduce the incidence of Haemophilus influenzae among sickly children.

infectious disease doctor Bykov NI