Haemophilus influenzae is a Gram-negative coccobacillus that commonly infects the human respiratory tract and can cause serious invasive disease. The most virulent strain is type b, which most commonly causes meningitis in young children. Symptoms of H. influenzae infection vary depending on the site of infection but may include fever, respiratory distress, and neurological dysfunction. Treatment involves antibiotics like ceftriaxone. Routine vaccination against H. influenzae has dramatically reduced the incidence of invasive disease in countries where it is part of the standard childhood vaccine schedule.

1. Haemophilus influenza
SASHA BONDI Nursing Science student
UZCHS Nursing Science Department
Introduction
• It is a non-motile Gram negative coccobacillus, isolated primarily in the human respiratory tract.
• Six serotypes based on capsular poly saccharide have been identified (a-f)
• 95% of invasive disease is caused by the type b strain (Hib), most commonly meningitis
predominantly in infants (below 5 years of age)

2. Photomicrograph of Haemophilus Influezae as
seen using a Gramstain Technique
Cerebrospinal fluid culture positive for Haemophilus
Influenzae, type b

3. HOW ITS SPREAD
 The Hib bacterium is commonly present in the nose and throat.
 When an infected person talks, coughs or sneezes small droplets containing infectious agents into the air. The droplets in the air may be
breathed in by those nearby.
 By indirect contact with hands, tissues or other articles soiled by nose and throat discharges.

5. RISK FACTORS
Factors that predispose an individual to acquire Hib
Age, individuals above the age of 65, infants and children below the age of 5
Pregnancy, immune system lowered slightly during pregnancy.
Day-care-centres (crèche/preschool)
Weakened immune system precipitated by medical conditions such as HIV, sickle cell anaemia, Asplenia,
diabetes e.t.c.
INCUBATIOIN PERIOD
time between becoming infected and developing symptoms
2-4 days

6. Infections by Hib
 meningitis which often follows an upper respiratory infection
 bloodstream infection (bacteraemia)
 epiglottitis (swelling of part of the throat which may result in obstruction to breathing)
 pneumonia (lung infection or inflammation)
 bone and joint infections
 cellulitis (infection of tissue beneath the skin)
 Children or adults with meningitis or epiglottitis should receive urgent medical assessment.

7. CLINICAL MANIFESTATIONS
Most infections occur in unimmunised or incompletely immunised children
o Meningitis, most common and most serious, comes with a fever, altered CNS function, nuchal rigidity.
o Epiglotitis, occurs in 2-7 year olds, adults have been known to develop it too, sudden onset with sore throat. Fever, dyspnoea, develops
dysphagia, pooling of oral secretions and drooling, children are anxious and restless, often adopt sitting position with neck extended, chin
protruding to minimise airway obstruction.
o Pneumonia (more common in poor developing countries), empyema
o Bacteraemia (6 months to 3 years)
o Anorexia and lethargy
o Cellulitis, manifested by fever and a warm, raised, tender area with a distinctive red-blue hue usually on the cheek or periorbital area
o Septic arthritis usually in single large weight bearing bone in children under 2 years
o Myalgia, chest pain, head-ache, cough

8. COMPLICATIONS
• Recurrent and chronic otitis media causes prolonged middle ear effusions, which lead to conductive hearing loss. Prolonged middle ear
effusions may lead to delays in speech and language development because of muffled hearing at a critical time in development.
• Neonatal sepsis due to nontypeable H.influenza is associated with a 50% mortality overall and 90% mortality in premature children
• Bacteraemia can result in the loss of limbs (septic arthritis).
• Subdural effusions are a common complication of Hib meningitis
• Children who survive Hib meningitis may develop permanent neurological disability, including brain damage, hearing loss and mental
retardation
• A potentially fatal complication of Epiglottitis is upper airway obstruction.

9. Periorbital cellulitis
Swollen face due to Hib infection

10. Haemophilus Influenza type b cellulitis
of the arm
Hib cellulitis of the foot
Infant with Severe Vasculitis with Disseminated
Intravascular coagulation with gangrene of the
hand secondary to Hib septicaemia

11. Septic arthritis

12. Inferior view of a brain infected with Hib bacteria

13. DIAGNOSIS
Isolated exclusively from humans. No other natural host is known. It is recovered from the respiratory tract and
rarely, the genital tract. H. Influenza diagnosis is considered confirmed when the organism is isolated from a
sterile body site, sterile sites considered are cerebrospinal fluid, blood and concentrated urine.
 By microscopy, H. influenza isolated from cerebrospinal fluid or blood.
 The bacterial culture grows well on chocolate agar with added factor X (hemin) and factor V (nicotinamide adenine dinucleotide) at 37° C in
a Carbon dioxide enriched incubator. The cultured organism can be further characterized using catalase and oxidase tests, both of which
should be positive.
 The latex particle agglutination test (LAT). It is more sensitive than a culture. Method relies on antigen rather than viable bacteria, this being
of great benefit as antibody use prior to sample collection kills the bacteria before identification is possible.
 Polymerase chain reaction assays have been proven to be more sensitive than either LAT or culture tests, and are highly specific. However
PCR assays have not yet become routine in clinical settings.

14. PREVENTION AND TREATMENT
• Preferred treatment for H. influenza type b meningitis is intravenous cephalosporin like ceftriaxone, cefotaxime or cefucoxime.
Corticosteroids (dexamethasone preferred) are also used to reduce swelling and prevent brain damage. For epiglottitis
amoxicillin/clavulanate, azithromycin, fluoroquinolones, cephalosporins or clarithromycin can be used. In advanced epiglottitis a
tracheostomy would have to be performed, to aid the patient in breathing. Pregnant women are given rifampicin.
• A child who has serious Hib infection cannot return to childcare, preschool or school until he or she has taken at least 4 days of an
appropriate antibiotic course. Under certain circumstances, Public Health authorities may recommend that an antibiotic such as rifampicin
is given to members of a household where there is a serious Hib infection and an immune-compromised individual, or to staff and other
children attending the same childcare centre. This is known as Rifampicin Prophylaxis
• Immunisation is routinely given to all children through the National Immunsation Program. The first dose of Hib vaccine, in combination
with other vaccines, is now recommended to be given at 6 weeks of age. The Hib vaccine is also recommended for any people who have no
spleen or a non-functioning spleen or who receive stem cell transplants
• The most effective way to control the disease and pathogen is to have good hygiene: observing respiratory etiquette such as covering your
mouth and nose when coughing, sneezing into a handkerchief or into ones shirt and the most imperative is wash hands before eating or
touching ones face.

15. Preferred treatment Amoxicillin/Clavulanate, 875 mg, PO,bd
Oral second or third generation cephalosporin(eg
cefuroxime 250-500 mg,PO twice daily OR
cefexime,cefpodoxime,cefaclor, or loracarbef)
Alternatives Fluoroquinolones (eg levofloxacin 500mg Po once daily,
moxifloxacin 400mg, PO once daily)
Macrolides (azithromycin 500mg then 250 mg once daily* 5-
10days) covers 80-90% of strains
Severe infections (Pneumonia, meningitis, epiglottitis)
Parenteral therapy
Ceftriaxone 1-2g IV once daily
Cefotaxime 2g IV q4-6hrs
Ciprofloxacin 400mg IV q12hrs
Levofloxacin 750 mg IV
Moxifloxacin 400mg IVq24hrs
Meningitis (only) Dexamethasone 0,6mg/kg/d divided into 4 doses for
children below 2 q6hrs 2-4 days; decreases risk of
deafness/neurological sequelae
Chemoprophylaxis Rifampicin 20mg/kg (maximum 600mg) once daily for 4 days
For neonates
10mg/kg once daily for 4 days

16. Hib VACCINE
 vaccine prevents meningitis, pneumonia, epiglottitis, and other serious infections caused by Hib
 Children over 5 years old and adults usually do not need Hib vaccine. But it may be recommended for older children or adults with Asplenia
or sickle cell disease, before surgery to remove the spleen, or following a bone marrow transplant. It may also be recommended for people
5 to 18 years old with HIV.
 Here in Zimbabwe the vaccine is given as a pentavalent along with diphtheria, tetanus, pertussis and hepatitis B vaccines as a pentavalent
vaccine (DPT,HepB,Hib). It is given at 6 weeks, 10 weeks and 14 weeks, then a booster is given at 2 years. Children that are sick do not get
the vaccine as the health care provider will not be able to tell if the effects are due to the vaccine or the underlying sickness.
 Hib vaccine should not be given to infants younger than 6 weeks of age.
 A person who has ever had a life-threatening allergic reaction after a previous dose of Hib vaccine, OR has a severe allergy to any part of
this vaccine, should not get Hib vaccine.

20. VACCINE SUCCESS RATE
• Hib conjugate vaccines have been shown to be universally effective against all manifestations of Hib disease, with a clinical
efficacy among fully vaccinated children estimated to be between 95–100%.
• The vaccine has also been shown to be immunogenic in patients at high risk of invasive disease
• Prior to introduction of the conjugate vaccine, Hib was a leading cause of childhood meningitis, pneumonia, and
epiglottitis
• Since routine vaccination began, the incidence of Hib disease has declined greatly and although Zimbabwe continues to
battle the disease causing agent the gains made in reducing mortality an morbidity are encouraging

22. PROGNOSIS
This infection is deadly but if treatment is sought early, it greatly improves the chances of survival and it greatly
reduces morbidity. It is highly encouraged for children under the age 5 to be vaccinated against the Hib disease as
this increases their chances of survival and reduces morbidity.
NURSING DIAGNOSIS
Ineffective Airway Clearance
Ineffective breathing pattern
Hyperthermia
Acute pain
 Deficient Knowledge

23. REFERENCES
• Practical Medical Microbiology, Mackie and McCartney
• Diagnostic Microbiology, Bailey and Scott
• Text book of Microbiology and Immunology, Parija
• A Textbook of Microbiology, Chakraborty
• www.who.int/immunisation/topics/hib Accessed 18 December 2017
• www.cdc.gov/hi-disease/about/diagnosis-treatment Accessed 18
December 2017
• www.health.ny.gov/diseases/communicable/haemophilus_influenzae
/fact_sheet Accessed 18 December 2017

24. THANK YOU
Maita Basa
Barka