BACKGROUND: Haemophilus influenzae (HI) is an exceedingly rare cause of infective endocarditis (IE).
UNASSIGNED: We present a case of a 90-year-old female diagnosed with HI-IE involving the native tricuspid valve in the absence of traditional risk factors for right-sided endocarditis. She was treated with a 5-week course of IV Ampicillin from negative cultures and suffered no complications. We also conducted a thorough literature review through PubMed and Google Scholar, which yielded a mere 15 reported cases of HI-IE.
RESULTS: Fourteen of the reported HI-IE cases included epidemiological data, showing no gender predominance. The mean age of the subjects was 39.5, with the mitral valve being the most implicated (64%) and tricuspid valve involvement being rare (21%).
CONCLUSIONS: Native tricuspid valve IE is an uncommon entity, especially in the absence of IV drug use. Haemophilus influenzae is an extremely rare cause of IE, with a literature review showing merely 15 reported cases. This article cites the 16th case of HI-IE published in the literature.

BACKGROUND: Haemophilus influenzae (Hi) can cause severe disease in children. This study aimed to identify risk factors related to invasive Hi disease in Alaska children and evaluate carriage in people around them.
METHODS: From 2005 to 2011, we investigated episodes of invasive, typeable Hi disease in Alaska children <10 years old. Three age-matched control children were enrolled for each case-patient. We evaluated oropharyngeal Hi carriage in people in close contact with Hi case-patients (contacts) as well as control children and their household members. Individual and household risk factors for illness and carriage were evaluated using questionnaires and chart reviews.
RESULTS: Thirty-eight of 44 (86%) children with invasive, typeable Hi disease were recruited: 20 Hi serotype a (53%), 13 serotype b (Hib) (34%) and 5 serotype f (13%). Children with the invasive Hi disease were more likely than controls to have underlying health problems (67% vs. 24%, P = 0.001), other carriers of any Hi in their household (61% vs. 15%, P < 0.001), and inadequate Hib vaccination (26% vs. 9%, P = 0.005). People who carried Hi were younger than noncarriers (mean 12.7 vs. 18.0 years, P = 0.008). The carriage was clustered within case-patient households, with carriage in 19% of household contacts, while only 6.3% of nonhousehold contacts and 5.5% of noncontacts carried the Hi serotype of interest ( P < 0.001).
CONCLUSIONS: Factors associated with invasive Hi disease in children included underlying health problems, household carriage and inadequate Hib vaccination. The high level of carriage in case-patient households is important to consider when evaluating treatment and prophylaxis strategies.

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We report for the first time in Portugal a serotype c Haemophilus influenzae isolated from an adult, with HIV-1 infection. Whole-genome sequencing characterized the isolate as clonal complex ST-7, albeit with a novel MLST (ST2754) due to a unique atpG profile. Integration of this genome with other available H. influenzae serotype c genomes from PubMLST revealed its overall genetic distinctiveness, with the closest related isolate being identified in France in 2020. This surveillance study, involving collaboration among hospitals and reference laboratory, successfully contributed to the identification and characterization of this rare serotype.

This study reports a case of respiratory failure and pneumonia attributed to infection from a confirmed case of Haemophilus influenzae in a patient with past medical history of interstitial lung disease following a COVID-19 infection. An 88-year-old man with significant past medical history of interstitial lung disease (ILD) and self-catheterization due to benign prostatic hyperplasia (BPH) presented to the ED with shortness of breath and cough. Examination revealed reduced respiratory effort and scattered rhonchi throughout the lung fields. Urine cultures were positive for extended spectrum beta-lactamase (ESBL) Escherichia coli. In addition, blood cultures and chest X-ray findings confirmed a case of H. influenzae bacteremia and pneumonia. The following case highlights the unusual finding of invasive H. influenzae disease and corresponds with the data provided by the Active Bacterial Core surveillance supported by the Centers for Disease Control and Prevention (CDC).

UNASSIGNED: In this comparative case study, we discuss clinically relevant discrepancies of antimicrobial susceptibility testing (AST) interpretation for ceftriaxone against a non-typable, beta-lactamase negative, ampicillin-resistant (BLNAR) Haemophilus influenzae isolated from a blood culture.
UNASSIGNED: A 74-year-old man presented with a 3 day illness characterized by shortness of breath and dry cough, and was noted to be febrile and hypoxic on admission. A blood culture bottle flagged positive with Gram-negative coccobacilli, later identified as Haemophilus influenzae with the patient commenced on ceftriaxone. The isolate was beta-lactamase negative and antibiotic susceptibility testing (AST) using disc diffusion revealed the isolate resistant to ceftriaxone and ampicillin by EUCAST methodology, with the patient subsequently changed to amoxicillin/clavulanate. Further AST using the CLSI methodology in parallel demonstrated discrepant results between the two susceptibility methods. The patient recovered without complications.
UNASSIGNED: This discrepancy could lead to inconsistent reporting of susceptibilities between laboratories, and consequently antibiotic prescribing, especially for invasive isolates. As more laboratories adopt EUCAST methodologies for AST interpretation in Australia and globally, it is important for clinicians to consider the clinical implications of these methodological discrepancies.

A 60-year-old female was admitted to internal medicine with a painful left knee after a fall and pneumonia. She had undergone a primary cemented left total knee arthroplasty in 2019 and a right cemented total knee arthroplasty in 2021. She had also a history of rheumatoid arthritis treated with steroids and a Janus kinase 1 (JAK1) inhibitor (upadacitinib). On admission intravenous antibiotic therapy was started for the treatment of pneumonia (piperacillin/tazobactam). Because of the persistent left knee pain, a knee puncture was carried out and confirmed a periprosthetic infection. A peripheral blood culture taken on admission day showed Haemophilus influenzae. She underwent a knee arthrotomy with debridement, irrigation, explantation of the knee prosthesis and spacer placement. Intraoperative cultures showed Haemophilus influenzae. The isolate was identified as a nontypeable Haemophilus influenzae strain by the reference laboratory. Haemophilus influenzae strains rarely cause invasive diseases. Rheumatoid arthritis with immunosuppressive therapy may have predisposed this patient to severe invasive disease. The clinical presentation of an infection may differ markedly in patients with rheumatoid arthritis from that in patients without rheumatoid arthritis or immunosuppression.
UNASSIGNED: Eine 60-jährige Frau wurde mit einem schmerzhaften linken Knie nach einem Sturz und einer Lungenentzündung in die Innere Medizin eingeliefert. Sie hatte 2019 eine primäre zementierte linke Knie-Totalendoprothese und 2021 eine zementierte rechte Knietotalendoprothese erhalten. Außerdem hatte sie eine rheumatoide Arthritis, die mit Steroiden und einem JAK1-Inhibitor (upadacitinib) behandelt wurde. Bei der Aufnahme wurde mit einer intravenösen Antibiotikatherapie zur Behandlung einer Lungenentzündung begonnen (Piperacillin/Tazobactam). Aufgrund der anhaltenden Schmerzen im linken Knie wurde eine Kniepunktion durchgeführt, die eine periprothetische Infektion bestätigte. Eine am Aufnahmetag entnommene periphere Blutkultur wies Haemophilus influenzae nach. Die Patientin unterzog sich einer Kniearthrotomie mit Débridement, Spülung, Explantation der Knieprothese und Einsetzen eines Spacers. Intraoperative Kulturen zeigten Haemophilus influenzae. Das Isolat wurde vom Referenzlabor als „nontypeable“ Haemophilus-influenzae-Stamm identifiziert. Haemophilus-influenzae-Stämme verursachen selten invasive Erkrankungen. Die rheumatoide Arthritis mit immunsuppressiver Therapie könnte unsere Patientin für eine schwere invasive Erkrankung prädisponiert haben. Das klinische Bild einer Infektion kann sich bei Patienten mit rheumatoider Arthritis deutlich von demjenigen bei Patienten ohne rheumatoide Arthritis oder Immunsuppression unterscheiden.

While Haemophilus influenzae type B (Hib) is well described in the literature to cause osteomyelitis, non-typeable H. influenzae has not. In areas where vaccination is routine, the prevalence of Hib has declined, whereas, in contrast, the prevalence of non-typeable H. influenza has increased. Generally, the non-typeable strains are less invasive but can access the vascular system by transmural migration through epithelial tight junctions or by an independent intercellular mechanism. Herein, we described a case of a 79-year-old man with the first case of non-typeable H. influenzae causing cervical osteomyelitis with associated bacteremia in an elderly adult.

Haemophilus influenzae is an uncommon uropathogen with fastidious growth requirements, which must be taken into consideration in the diagnostic process. We present a rare case of urosepsis with H. influenzae in a young patient with nefrocalcinosis.

UNASSIGNED: Necrotizing fasciitis is an aggressive skin and soft tissue infection that is a surgical emergency, and Haemophilus influenzae (H. flu) is a rare cause. We present a case of H. flu co-infection causing necrotizing fasciitis in the setting of COVID-19 pneumonia.
METHODS: A 56-year-old male presented with 2 weeks of upper respiratory symptoms. He was unvaccinated against COVID-19 and tested positive for COVID-19 five days prior. He developed respiratory failure requiring intubation, and was treated with dexamethasone, remdesivir, and tocilizumab for COVID-19 pneumonia. On hospital day 2, he was hypotensive with new rapidly evolving erythematous lesions with crepitus of his lower extremities suspicious for necrotizing fasciitis. He underwent wide excision and debridement with significant hemodynamic improvements. H. flu co-infection was identified from blood cultures. Aberrant cells with 94 % lymphocytes were noted and suggested chronic lymphocytic leukemia (CLL) that was not previously known. He developed progressive lesions globally, concerning for purpura fulminans with clinical disseminated intravascular coagulation and neurological decline ultimately leading to withdrawal of care.
UNASSIGNED: COVID-19 infection is often associated with concomitant opportunistic infections. Our patient was also immunocompromised by CLL, diabetes, chronic steroids, and initial appropriate COVID-19 treatments. Despite appropriate treatments, he could not overcome his medical comorbidities and multiple infections.
CONCLUSIONS: Necrotizing fasciitis caused by H. flu is rare, and we present the first case as a co-infection in the setting of COVID-19 pneumonia. Due to the patient\'s immunocompromised state with underlying CLL, this proved to be fatal.