Necrotizing Fasciitis Caused by
            <i>Haemophilus influenzae</i>
            Type b in an Elderly Patient

Saito, Takashi; Matsunaga, Hiromi; Matsumura, Yasuhiro; Segawa, Hajime; Takakura, Shunji; Nagao, Miki; Iinuma, Yoshitsugu; Ichiyama, Satoshi

doi:10.1128/jcm.01196-08

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…In addition, low Hib circulation rates due to the vaccine's "herd effect" may account for reduced maintenance of natural anti-Hib immunity in nonvaccinated populations (14). Severe cases of invasive Hib disease affecting adults have been reported (6,40). As Hib continues to circulate in countries with high pediatric Hib vaccine coverage (31), the public health guidelines recommend adult vaccination for some high-risk groups (anatomical or functional asplenia, congenital antibody, or complement deficiency) (34).…”

mentioning

confidence: 99%

Risk of Invasive Haemophilus influenzae Type b (Hib) Disease in Adults with Secondary Immunodeficiency in the Post-Hib Vaccine Era

Nix

Hawdon

Gravelle

et al. 2012

Clin. Vaccine Immunol.

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ABSTRACTPrior to the introduction ofHaemophilus influenzaetype b (Hib) conjugate vaccines, invasive Hib disease affected almost exclusively children. According to some recent studies, in the postvaccine era, adults, the elderly, and immunocompromised persons can be affected more often than children. As the production of type-specific anti-capsular polysaccharide antibodies is the major defense mechanism against Hib, individuals with defects in humoral immune responses have high susceptibility to infections caused by Hib. We hypothesized that nonvaccinated adults with chronic conditions causing immunosuppression may lack protective antibody to Hib. We assessed serum anti-Hib IgG levels and bactericidal activity in 59 patients with chronic renal failure, 30 patients with type 2 diabetes mellitus, 28 patients with chronic obstructive pulmonary disease (COPD), and 20 patients with multiple myeloma compared to 32 healthy controls of similar age. Considering antibody at >0.15 μg/ml as the protective correlate in unvaccinated individuals, we detected subprotective Hib antibody levels in 29% of chronic renal failure, 20% of diabetes, 14% of COPD, and 55% of myeloma patients compared to 3% of healthy controls. Additionally, 70% of myeloma and 58% of chronic renal failure patients did not have detectable serum bactericidal activity against Hib. Among individuals with severe diseases causing secondary immunodeficiency, patients with multiple myeloma and chronic renal failure are at an increased risk of invasive Hib disease. Considering that Hib continues to circulate in the population, this study provides a rationale for the immunization of some adult patients with secondary immunodeficiency with the pediatric Hib vaccine to achieve protective immunity.

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confidence: 99%

Risk of Invasive Haemophilus influenzae Type b (Hib) Disease in Adults with Secondary Immunodeficiency in the Post-Hib Vaccine Era

Nix

Hawdon

Gravelle

et al. 2012

Clin. Vaccine Immunol.

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“…Monomicrobial (type 2) necrotizing fasciitis occurs less commonly, and is most often caused by streptococci. There are only eight published accounts of monomicrobial necrotizing fasciitis due to H. influenzae (Table 1) in the literature (Chalmers, 2010;Collette et al, 1987;Lee & Ip, 2010;McLellan et al, 2008;Robinson et al, 2010;Saito et al, 2009;Stumvoll & Fritsche, 1997;Ugai et al, 2014). To the best of our knowledge, this is the first report of monomicrobial cervicofacial necrotizing fasciitis due to H. influenzae.…”

Section: Discussionmentioning

confidence: 83%

“…Other epidemiological reports have suggested that the shift has been predominantly towards non-typable strains (Agrawal & Murphy, 2011). Among the previously reported cases of necrotizing fasciitis secondary to H. influenzae, five were Hib (Chalmers, 2010;Collette et al, 1987;Lee & Ip, 2010;Saito et al, 2009;Ugai et al, 2014), one was Hie (Robinson et al, 2010), one was serotype f (Hif) (McLellan et al, 2008) and one was non-typable (Stumvoll & Fritsche, 1997).…”

Section: Discussionmentioning

confidence: 98%

Cervicofacial necrotizing fasciitis caused by Haemophilus influenzae serotype e in a patient with Sjogren's syndrome, systemic lupus erythematosus and hypocomplementaemia

et al. 2015

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Introduction: Haemophilus influenzae has the potential to lead to invasive disease including necrotizing fasciitis, especially in immunocompromised individuals. There are only eight previous reports of monomicrobial necrotizing fasciitis due to this organism, and, to the best of our knowledge, none of the head and neck. There is also limited epidemiological and clinical data on infections caused by non-b serotypes of H. influenzae, including serotype e.Case presentation: A 60-year-old female, with systemic lupus erythematosus, Sjogren's syndrome and hypocomplementaemia, presented with rapidly progressive right-sided facial and neck pain, swelling and erythema. She was treated initially with broad-spectrum antibiotics and underwent emergent debridement of the infected tissues. Intraoperative cultures and blood cultures grew H. influenzae. She required two additional debridements and was treated with ceftriaxone for 3 weeks with resolution of her symptoms. Conclusion:Here, we present the first reported case, to the best of our knowledge, of cervical necrotizing fasciitis due to H. influenzae serotype e. This case highlights the continued clinical importance of H. influenzae as a cause of invasive disease, including necrotizing fasciitis, particularly in immunocompromised individuals. Moreover, the case provides an example of invasive H. influenzae infection caused by a non-b serotype, an emerging concern in the era of widespread H. influenzae serotype b vaccination.

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“…In our review, there are only 10 cases of necrotizing fasciitis associated with H. influenzae reported in the literature, 7 of which occurred in adults (Table 1) (2,(5)(6)(7)(8)(9)(10)(11)(12)(13). Three cases were secondary to Hif infection, as occurred for our patient.…”

mentioning

confidence: 89%

“…However, despite a remote history of breast cancer, our patient was otherwise healthy and in excellent physical condition at the time of presentation. Also, in the review of the prior reported cases, at least four were found to have occurred in relatively healthy individuals (5,7,9,12). In one case of a previously healthy man, an IgG3 and mannose-lectin binding deficiency was later discovered, which was thought to have possibly been a predisposing factor (5).…”

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confidence: 99%

Necrotizing Fasciitis Caused by Haemophilus influenzae Serotype f

et al. 2014

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cHaemophilus influenzae is a rare cause of soft tissue infection. In this report, we present a case of multifocal necrotizing fasciitis in a healthy adult patient, secondary to Haemophilus influenzae serotype f infection, and we review literature on this rare cause of necrotizing fasciitis. CASE REPORTA 63-year-old female came to the Duke University Medical Center Emergency Department in February 2013 because of a fever and increasing right hip and right shoulder pain that had occurred over a 5-day period. Her medical history was notable for stage II breast cancer treated with a left mastectomy and six cycles of cyclophosphamide and adriamycin in 1996 and for hypothyroidism, mitral valve prolapse, and hyperlipidemia.Several days prior to hospitalization, the patient had cared for a grandchild with a mild upper respiratory illness. Two days later, the patient noted mild throat discomfort. The following day, she went on a 4-mile run and then did yoga and weight training. Later that day, chills occurred. Her temperature rose to 104°F, and she took ibuprofen. The next morning, she noted pains in her right groin and right shoulder and sought evaluation at a local emergency department. Results of basic laboratory testing and a nasal swab for influenza virus were normal or negative; thus, she was discharged without a specific diagnosis and with instructions to take analgesics and rest. The following day, her right shoulder and groin pain were worse. She was seen in the office of an orthopedic surgeon, who prescribed methyl prednisolone. Her pain intensified over the next 2 days, and thus, she went to the Emergency Department at Duke University Medical Center, where an examination showed a normal temperature and blood pressure. Passive and active movements of her right shoulder and right hip were limited by pain. The soft tissues overlying the right shoulder from the deltoid to the midhumerus and from the region of the pubic symphysis to the right medial thigh were indurated and erythematous. Initial laboratory tests showed the following: C-reactive protein (CRP) level, 37.6 mg/dl; erythrocyte sedimentation rate (ESR), 91 mm/h; creatinine level, 2.7 mg/dl; platelet count, 110 ϫ 10 9 cells/liter; white blood cell count, 2.4 ϫ 10 9 cells/liter (36% bands); aspartate transaminase (AST) level, 48 U/liter; and creatinine kinase level, 195 U/liter (30 to 220 U/liter). Blood and urine specimens were obtained for cultures, and treatment with vancomycin and ceftriaxone was initiated.Following admission, ceftriaxone was discontinued, and treatment with clindamycin and cefepime was begun. A consulting orthopedic surgeon attempted to aspirate the right shoulder, but no joint fluid could be detected. Aspiration of the right hip recovered a small amount of fluid containing 83 white blood cells/l (44% polymorphonuclear cells); no organisms were seen on the Gram stain. A subsequent magnetic resonance imaging study revealed findings consistent with nonspecific myositis and fasciitis involving the right shoulder and arm and right hip and...

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Necrotizing Fasciitis Caused by Haemophilus influenzae Type b in an Elderly Patient

Cited by 11 publications

References 10 publications

Risk of Invasive Haemophilus influenzae Type b (Hib) Disease in Adults with Secondary Immunodeficiency in the Post-Hib Vaccine Era

Risk of Invasive Haemophilus influenzae Type b (Hib) Disease in Adults with Secondary Immunodeficiency in the Post-Hib Vaccine Era

Cervicofacial necrotizing fasciitis caused by Haemophilus influenzae serotype e in a patient with Sjogren's syndrome, systemic lupus erythematosus and hypocomplementaemia

Necrotizing Fasciitis Caused by Haemophilus influenzae Serotype f

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