What is Hemophilic Infection in Children?
A hemophilic infection is an infection that causes purulent meningitis, otitis media, various respiratory diseases (such as bronchitis, pneumonia), endocarditis, conjunctivitis, osteomyelitis in children, etc.
Haemophilus influenzae is a conditionally pathogenic microorganism that can lead to epidemic outbreaks among young children. Diseases in such cases are provoked by an epidemic clone of the pathogen with increased pathogenic and invasive properties. Outbreaks of infections occur in maternity hospitals, departments for patients with chronic diseases, among those undergoing treatment with hormonal and cytostatic drugs.
The infection is transmitted and transmitted to healthy people by patients who have obvious or erased forms of the disease, as well as carriers (healthy people whose organisms contain a hemophilic infection). The main route of transmission is airborne. Also among the transmission factors are linen, toys, various items. Children can become infected by contact with their parents, medical staff, and each other. Children with signs of immunodeficiency (both primary and secondary) are most susceptible.
Causes of Haemophilus Influenzae in Children
Haemophilus influenzae – gram-negative pleomorphic rod-shaped or coccoid cells, whose size is 0.2-0.3×0.5-2 microns. They are arranged in pairs or alone, and can also form short chains or groups. On dense media, small round colonies are formed, without color, with a diameter of up to 1 mm.
Haemophilus influenzae is immobile, does not form spores, but can form capsular forms, which are believed to have pathogenic properties. The causative agent produces endotoxin. 6 serotypes are distinguished, denoted by Latin letters from a to f. The microorganism is pathogenic only for humans.
Pathogenesis during Hemophilic Infection in Children
Factors of the development of the disease are considered to be an early age and a decrease in local protection and general specific reactivity. Also, the disease develops with a genetic predisposition, the formation of an epidemic clone of the pathogen, mixed infection.
In the children’s body, the pathogen, as a rule, “settles” on the mucous membranes of the nasopharynx and respiratory tract. It can be located inside and outside the cells. Endogenous infection occurs in conditions of total depression of cellular and humoral immunity, usually manifesting as a complication of ARVI or other viral or bacterial infection.
With exogenous (external) infection, bacteria enter the mucous membranes of the respiratory tract, causing an inflammatory process that occurs like pneumonia, bronchitis, tonsillitis, otitis media, etc. Phlegmon, abscess, sepsis, and purulent meningitis can also form.
Symptoms of Haemophilus Influenzae in Children
Depending on where the process is localized, hemophilic infection provokes meningitis, pneumonia, osteomyelitis, otitis media, acute epiglottitis. Common clinical forms for newborns are conjunctivitis, septicemia, purulent arthritis, mastoiditis, etc.
Pneumonia provoked by H. influenzae is fixed to 5% of all cases of pneumonia. The disease affects mainly children under 2 years old. The disease has an acute onset, body temperature is greatly increased, catarrhal phenomena and severe toxicosis are observed. Symptoms are similar to those with other pneumonia of a bacterial nature.
Percussion and auscultation can detect the site of inflammation in the projection of one or more segments of the lungs. Most often, the process is localized in the basal zones, but can affect the lower and upper lobes of one or both lungs. There is a chance of abscess formation. The X-ray diffraction pattern shows foci of homogeneous dimming or dense focal-confluent shadows in the event of exudative pleurisy.
Changes in the blood can be different and depend on each individual case. In some cases, a high white blood cell count, neutrophilic shift and ESR are higher than normal. But in more frequent cases, the number of leukocytes is normal or slightly increased, and ESR only tends to increase.
In the diagnosis, decisive importance is attributed to the positive results of blood culture and pleural effusion.
Meningitis caused by H. influenzae is the main causative agent of purulent meningitis in children under 3 years of age. In the main risk group – babies of the first months of life. Symptoms of this meningitis are similar to those of other purulent meningitis. The disease begins acutely, with fever (temperature reaches 39-40 ° C), the appearance of general infection toxicosis with repeated vomiting, complete sleep disturbance, agitation, tremor of the hands and chin.
Babies up to 4 months old may have bulging large fontanel, hyperesthesia, and in more rare cases, stiff neck, positive symptoms of Kernig, Brudzinsky are noted. Changes in cerebrospinal fluid have very few differences from changes in meningococcal or pneumococcal meningitis.
Hemophilic meningitis in children, as a rule, is difficult. Lethal outcomes are frequent. The following residual phenomena are recorded in survivors: convulsive syndrome, paralysis, decreased intelligence, increased irritability, impaired hearing, speech, etc.
Panniculitis is also known as cellulite. This is an inflammation of fatty tissue in children up to 12 months old. The onset of the disease is characterized by the appearance of dense painful areas of bluish-red or violet color with a diameter of 1 to 10 cm or more on the scalp, neck, cheeks, or periorbital region. At the same time, purulent meningitis, otitis media, pneumonia, etc. can occur.
A histological examination of the affected areas of the skin reveals an inflammatory infiltrate, which consists of red blood cells, white blood cells, histiocytes and lymphocytes. The diagnosis is confirmed by blood culture on culture media to isolate H. influenzae. Antibiotic therapy is carried out until the lesions disappear and the temperature returns to normal.
Acute epiglottitis is also known as inflammation of the epiglottis. This is a severe form of hemophilic infection in children from 2 to 5 years. The disease begins acutely, the temperature rises quickly and strongly, sharp pains in the throat appear. Symptoms such as severe shortness of breath, inability to swallow, narrowing or obstruction of the larynx in the epiglottis are also noted, resulting in respiratory distress. In some cases, symptoms such as excessive salivation, aphonia, cyanosis, pallor are observed. The patient has swollen nose wings.
Breasts, in the absence of meningeal symptoms, often throw their heads back. In older children, when examining the oropharynx, an edematous red epiglottis is revealed. Also, the inflammatory process occurs in the subglottic space.
Epiglottitis is usually severe. After a few hours, there is a chance of obstruction of the larynx, loss of consciousness, and death, unless urgent nasotracheal intubation or tracheotomy is started.
Hemophilic pericarditis, according to American literature, accounts for about 15% of all cases of pericarditis in children. According to the symptoms, the disease is similar to pericarditis of another bacterial nature. Symptoms of hemophilic pericarditis in children: high body temperature, tachycardia, expansion of the boundaries of cardiac dullness, respiratory disturbances, deafness of heart sounds. The disease is very difficult, deaths are frequent.
Purulent arthritis. In our country, arthritis caused by H. influenza is extremely rare. The disease affects large joints: ulnar, knee, shoulder, hip. The symptoms of this arthritis are similar to those of other bacterial etiology.
Purulent arthritis in children can be combined with other diseases of a hemophilic nature – cellulitis, purulent meningitis, etc. The final diagnosis requires blood cultures and intraarticular fluid, as well as studies of gram stained brains.
Osteomyelitis caused by H. influenzae is characterized by the defeat of large tubular bones: tibia, femur, and humerus. For diagnosis, bacteriological cultures of bone marrow aspirate and Gram stained smears are used.
In newborns, a hemophilic infection is often generalized, with symptoms of septicemia or septicopyemia, the occurrence of multiple lesions. A large percentage of death in the outcome of the disease, because the course is very severe.
Diagnosis of Haemophilus Influenzae in Children
Laboratory tests are needed to diagnose hemophilic infections in children. They take such biomaterial as pus, sputum, cerebrospinal fluid, aspirate from the lesion site. The material is stained by Gram (microscopic), distinguished from pertussis bacillus, which H. influenzae has a great resemblance. Apply such methods as PCR, radar, ELISA.
Differential diagnosis is carried out depending on the clinical form. Purulent meningitis should be differentiated from bacterial meningitis: streptococcal, meningococcal, staphylococcal, pneumococcal.
It should be borne in mind that H. influenzae is often manifested by cellulitis (panniculitis) and acute epiglottitis. For differential diagnosis, laboratory research methods are needed.
Treatment of Hemophilic Infection in Children
Treatment of hemophilic infection in children is carried out using complex therapy, which is based on antibiotic therapy. Cephalosporins of the 3rd generation, azithromycin (sumamed) are mainly used. The drug is available in the form of powder, suspensions, tablets.
Also, the pathogen can be killed with chloramphenicol, rifampicin, gentamicin. Resistance of hemophilic infection to oxacillin, lincomycin, etc. is noted. In such cases, two antibiotics are prescribed. An antibioticogram should be made, after which the combination of drugs is adjusted. Recently, many strains of the pathogen are resistant to many antibiotics.
Symptomatic, stimulating and restorative treatment should also be given. It is especially important to timely open the focus of infection or to drain the pleural cavity.
Pneumonia caused by hemophilic bacillus is treated with 3rd generation cephalosporins, macrolides, ampicillin, chloramphenicol succinate, gentamicin, much less often – penicillin, rifampicin.
Prevention of Hemophilic Infection in Children
Sanofi Pasteur Act-HIB vaccine is used for active prevention. Recommended for children from 2 months of age. Non-specific preventive measures are important: young children, strict isolation of newborns, a complex of restorative and stimulating therapy, hygienic skin maintenance, etc.