Abstract
Haemophilus influenzae (H. influenzae) is a facultative anaerobe, pleomorphic Gram-negative coccobacillus capable of causing various respiratory and blood stream infections. Introduction of childhood immunization against H. influenza type b has decreased its prevalence. Invasive infection with non-typeable H. influenzae is increasing specially in vulnerable population. We present a case of a 69-year-old female who developed septic shock due to H. influenzae infection. She was also found to have influenza A infection in bronchoalveolar lavage (BAL) sample although initial test with nasopharyngeal swab was negative. This case report highlights the fact that in patients with high clinical suspicion, negative nasopharyngeal swab with polymerase chain reaction may not rule out influenza infection and BAL may be necessary to confirm the diagnosis and H. influenzae can be causing bacterial superinfection in such patients. She was appropriately treated with third-generation cephalosporin for H. influenzae and with oseltamivir for influenza A. Her condition improved significantly with the treatment.
Highlights
Haemophilus influenzae (H. influenzae) is a small, non-spore-forming coccobacillus classified into six serotypes (a-f) based on the capsule and non-typeable H. influenzae (NTHi) strains that lack a capsule
H. influenzae type b is the most virulent of all six serotypes but with widespread childhood immunization the prevalence has decreased and NTHi infection is more common in the United States
We present a patient with bacteremia due to H. influenzae and she was found to have influenza A infection
Summary
Haemophilus influenzae (H. influenzae) is a small, non-spore-forming coccobacillus classified into six serotypes (a-f) based on the capsule and non-typeable H. influenzae (NTHi) strains that lack a capsule. A 69-year-old female with a past medical history of atrial fibrillation, heart failure with reduced ejection fraction, hypertension, and chronic bilateral lymphedema presented to the emergency department with complaint of productive cough and shortness of breath for two days. She reported some associated fever, but temperature was not documented. She was up to date with vaccinations including flu shot and COVID19 vaccination On examination, her oxygen saturation was 82-83%, pulse rate 90 beats/minute, and blood pressure was normal. Amiodarone infusion was started for rapid ventricular response Her hospital course was complicated by worsening respiratory failure. She was planned to receive 14 days of antibiotics for Gram-negative bacteremia and five days of oseltamivir
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