Experience with Hemophilus Influenzae Pneumonia

Abstract

Hemophilus Influenzae is a gramnegative pleomorphic rod most commonly encountered as normal flora from throat cultures in all age groups, but as a pathogen, its role has been established in cases of meningitis, pyogenic arthritis, softtissue abscess, and pulmonary infections. The incidence of primary Hemophilus infiuenzae pneumonia and empyema diminished markedly after the introduction of the sulfonamides. The recent occurrence of two cases of unusually severe Hemophilus infiuenzae pulmonary infection in infants prompted the following review of our experience with this entity during the past five years. Selection of Cases The records of all patients discharged from two hospitals5 with the diagnosis of Hemophilus infiuenzae pneumonia during the period 1960–1965 were reviewed. In the majority of these cases, the etiologic diagnosis was established by nasopharyngeal culture. Only those cases with a positive blood or pleural effusion culture were included and evaluated further. Of 10 such patients, 3 were hospitalized in 1960, 1 in 1962, 2 in 1963, 1 in 1964, and 3 in 1965 (Table I). Age and Presenting Complaint Eight patients were between four months and two years of age. Two others were eight and seventy-five years old. Seven patients presented with respiratory complaints of seven days duration or more. One child suffered a pyogenic arthritis for one week; another with abdominal pain for one day was admitted for observation of "acute abdomen." Laboratory Findings Eight patients were anemic on admission. In 9 elevated leukocyte counts ranged from 11,600 to 60,400. Blood cultures were positive for Hemophilus injluenzae in 8 cases; in addition, one case from this group yielded a positive joint fluid culture. Pleural fluid showed Hemophilus injluenzae in the remaining 2 cases; in one of these a direct lung culture was positive as well. Radiographic Findings In 9 of the 10 cases, radiographs were available for evaluation. Films of CASE I were lost, although it was reported that right upper lobe pneumonia and bilateral pleural effusion were present on admission. Nine of the 10 cases had radiographic evidence of pneumonia on admission. In the exception (Case VII) minimal pleural change was evident along the lateral chest wall (Fig. 1). The pneumonia was clearly lobar or segmental in 7 cases (Figs. 2"7). In 2, the extent of effusion was such that the respective hemithorax appeared totally opacified; in these cases, individual lobar or segmental consolidation could not be clearly defined (Figs. 8 and 9). There was no predilection for consolidation of either the upper or lower lobes. The absence of solitary right middle lobe orlingular consolidations, so commonly seen in the pediatric age group, was conspicuous. The pneumonia involved the right lung in 7 cases and the left in 3. In all cases, as the consolidation resolved, there was no radiographic evidence of pneumatocele formation.