Symptoms of hemophilus influenzae

Haemophilus influenzae infection has an incubation period, which is apparently from two to four days. Haemophilus influenzae infection does not have a single classification. It is advisable to distinguish asymptomatic carriage, that is, when there are no symptoms of haemophilus influenzae infection, localized [ARI (nasopharyngitis), ARI complicated by sinusitis, otitis; phlegmon, cellulitis) and generalized (invasive) forms of the disease (epiglottitis, pneumonia, septicemia, meningitis, osteomyelitis, arthritis).

ARI caused by Haemophilus influenzae does not differ significantly from ARI of other etiologies, but is often complicated by otitis and sinusitis.

Epiglottitis is an inflammation of the epiglottis, a severe form of Hib infection. It is most often observed in children aged 2-7 years. The onset is acute: chills, high fever, salivation. Within a few hours, symptoms of respiratory failure increase (inspiratory dyspnea, tachycardia, stridor, cyanosis, retraction of the pliable areas of the chest). Patients take a forced position. Septicemia and meningitis may develop.

Phlegmon. Observed in children under 1 year old, most often localized in the head and neck. The clinical picture may resemble erysipelas. Bacteremia and meningitis are possible.

Cellulitis is also observed in children under 1 year; most often localized on the face and neck. Often develops against the background of nasopharyngitis. In the cheek area or around the eye socket, on the neck, hyperemia with a bluish tint and swelling of the skin appear. General intoxication is not expressed, but otitis, meningitis and pneumonia may join.

Pneumonia. Symptoms of hemophilic infection are no different from those of pneumococcal pneumonia. May be complicated by meningitis, pleurisy, septicemia.

Septicemia. Most often observed in children under 1 year of age. Characterized by hyperthermia, often hemorrhagic rash, and development of infectious toxic shock.

Osteomyelitis and arthritis usually develop against the background of septicemia.

Meningitis caused by Haemophilus influenzae type b (Hib meningitis) ranks 3rd in frequency of occurrence in the etiological structure of bacterial meningitis, accounting for 5 to 25%, and in children under 5 years of age - 2nd place (10-50%).

Having many common features with other types of bacterial meningitis, Hib meningitis is distinguished by a number of significant clinical and pathogenetic features that must be taken into account in early diagnosis and selection of optimal tactics of etiotropic and pathogenetic therapy.

Hib meningitis mainly affects children under 5 years of age (85-90%). Children under 1 year of age, including the first month of life, also often get sick (10-30%). Children over 5 years of age and adults account for 5-10% of cases. In most patients, Hib meningitis develops against an aggravated premorbid background (organic lesions of the central nervous system, aggravated course of the second half of pregnancy and childbirth, frequent respiratory infections in the anamnesis, disorders in the immune system). In children over 5 years of age and adults, anatomical defects (spina bifida) are of significant importance. These patients, as a rule, repeatedly suffer from bacterial meningitis of various etiologies.

The disease often begins subacutely: with a cough, runny nose, and an increase in body temperature to 38-39 °C. In some patients, dyspeptic disorders may dominate in the initial period. This period lasts from several hours to 2-4 days, then the child's condition worsens: intoxication symptoms intensify, the temperature reaches 39-41 °C, headache intensifies, vomiting, meningeal symptoms of hemophilic infection, disturbances of consciousness, convulsions join in, and after 1-2 days - focal symptoms. With an acute onset of the disease, catarrhal phenomena may be absent. In these cases, the disease begins with a rapid increase in body temperature to 39-40 °C, headache, vomiting. Distinct meningeal syndromes appear on the 1st-2nd day of the disease. On average, clear signs of CNS damage in Hib meningitis are noted 2 days later than in meningococcal meningitis, and 24 hours later than in pneumococcal meningitis. This often leads to late diagnosis and late initiation of etiotropic therapy.

Fever in Hib meningitis is often remittent or irregular, recorded even against the background of antibacterial therapy, lasting from 3-5 to 20 (on average 10-14) days or more. The fever level is higher than in bacterial meningitis of other etiologies. Rash is possible in some cases. Catarrhal phenomena in the form of pharyngitis are found in more than 80% of patients, rhinitis - in more than 50% of patients. Less often, bronchitis is noted, in some patients - pneumonia. Often the spleen and liver are enlarged: there is no appetite, vomiting, regurgitation of food, stool retention (but diarrhea is possible) occur. Lethargy, adynamia, rapid exhaustion are characteristic of most patients. Less often, sopor develops, in some cases - coma. Against the background of dehydration and adequate antibacterial therapy, consciousness is completely restored within 4-6 hours to 2-3 days. A pronounced picture of cerebral edema is observed in approximately 25% of patients, but signs of brain dislocation (coma, generalized seizures, respiratory distress) are detected much less frequently.

At the same time, focal neurological symptoms of hemophilic infection are found in at least 50% of patients. Most often, cranial nerve paresis, hearing loss, focal seizures, ataxia, extrapyramidal muscle tone disorders are noted, and, less often, limb paresis.

Meningeal syndrome (in particular, bulging fontanelle), suspension symptom are expressed moderately. Stiffness of the occipital muscles, as a rule, is characteristic of children over 1 year old, and Brudzinsky and Kernig symptoms are weakly expressed or absent in some patients. The cerebrospinal fluid picture is characterized by moderate neutrophilic or mixed pleocytosis, a slight increase in the protein level. Turbidity of the cerebrospinal fluid can be caused by a huge amount of hemophilic bacilli, which occupy the entire field of view under microscopy. The glucose content in the first 1-2 days varies from a sharp decrease to an increase in the level, after the 3rd day - less than 1 mmol / l or glucose is not detected.

The blood picture is characterized by mild or moderate leukocytosis: almost half of the patients have leukocytosis, the rest have normocytosis or leukopenia. Most patients have absolute lymphopenia (up to 300-500 cells in 1 μl), as well as a tendency to decrease the number of erythrocytes and hemoglobin.

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