Haemophilus influenzae b infection

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Classification according to ICD-10
J14 Haemophilus influenzae pneumonia
P23.6 Congenital pneumonia caused by other bacteria
- Haemophilus influenzae
G00.0 Haemophilus influenzae meningitis
A41.3 Sepsis from Haemophilus influenzae
A49.2 Haemophilus influenzae infection, unspecified
ICD-10 online (WHO version 2019)

The invasive Haemophilus influenzae b infection is one of the most serious bacterial infections in the first five years of life. The pathogen occurs only in humans and is mainly found on the mucous membranes of the upper respiratory tract .

The pathogen is Haemophilus influenzae type b (Hib), a gram-negative bacterium that is spread from person to person via droplet infection . The incubation period is two to five days. Thereafter, febrile infections of the nasopharynx with middle ear, sinus and pneumonia can occur. Dreaded complications are meningitis or inflammation of the epiglottis , which are accompanied by attacks of suffocation. Permanent damage and death are possible.

As long as germs can be isolated from the nasopharynx, there is a risk of infection . Re-infection occurs very rarely in children under two years of age. There is an increased risk of infection and complications with impaired function or after the spleen has been removed .

Clinical picture

Encapsulated or unencapsulated H. influenzae naturally colonize the mucous membranes , especially those of the upper respiratory tract. But you can z. B. lead to purulent infections as a result of a viral infection.

The bacteria are transmitted via droplet infection or direct contact; the incubation period is between two and five days. Both sick and healthy germ carriers can be contagious. The disease begins as a febrile infection of the nasopharynx and then can cause middle ear and sinusitis , acute bronchitis, and pneumonia , mostly from unencapsulated strains. In the case of otitis media, H. influenzae can also form biofilms that make therapy difficult.

Encapsulated strains such as H. influenzae type b but also strains of biotype I and II can occasionally overcome the mucosal barrier (mucosal barrier). The capsular polysaccharide mediates the virulence, the lipopolysaccharide also supports an invasive infection. Here, the bacteria enter between the epithelial cells in the submucosa and can from the nose Rachneraum through the bloodstream to other organs spread with the corresponding clinical picture ( sepsis , arthritis , osteomyelitis , cellulitis , pericarditis ).

The most serious or threatening complication is a purulent meningitis ( meningitis ). It can also result from an ear infection. It is clinically indistinguishable from meningococcal meningitis . The first symptoms are irritability, drowsiness, or vomiting . After 12 to 24 hours, the intracranial pressure increases with further symptoms ( cramps , unconsciousness , respiratory arrest , hypothermia , shock with consumption coagulopathy ). If left untreated, 20 to 60 percent of people who develop meningitis die. Even with timely treatment with antibiotics , the death rate is still more than five percent. After meningitis has been overcome, defects often heal with permanent damage to the nervous system such as hearing damage (including deafness ), visual disturbances (including blindness ) or mental disorders (20–40%). About five percent of children are severely physically and mentally handicapped after a Hib meningitis.

Further complications of an infection can be sudden inflammation of the epiglottis (acute epiglottitis ) or an acute narrowing of the larynx (laryngeal stenosis) with a risk of suffocation, pleurisy or joint inflammation, blood poisoning and periosteum inflammation. The full image develops within 2 to 24 hours. It is accompanied by a high fever and can reach a fulminant stage within a very short time . If life-saving intubation cannot be performed, most of them will die on the way to the doctor or clinic.

Secondary infections with H. influenzae occur in adults , for example after acute bronchitis or virus-induced pneumonia. In smokers, the epithelial barrier of the bronchial mucosa is already damaged due to the nicotine , which also favors invasion by unencapsulated, endogenous strains. This leads to chronic bronchitis (smoker's cough).

Before vaccines were available in third world countries, an estimated 371,000 children under the age of 5 died of this vaccine-preventable infection in 2000, and over 8 million children became ill. Today, as then, children between the ages of 6 months and 4 years are particularly affected. Hib infection leaves an immunity to Hib.

therapy

A diagnosed infection is countered with the administration of ampicillin ; therapy should begin as early as possible. A possible resistance to this antibiotic is transmitted plasmid-coded and is increasingly observed. Therefore, third generation cephalosporins (10–15% intravenous) or quinolones or macrolides (e.g. clarithromycin ) are recommended.

If children develop acute otitis media as a result of the infection, mild cases are not treated with antibiotics, otherwise with amoxicillin . The parallel administration of clavulanic acid can counteract the β-lactamase of Hib.

Chemoprophylaxis

In the case of meningitis (meningitis) caused by Haemophilus influenzae, close contact persons of the patient receive chemoprophylaxis with rifampicin , pregnant women with 500 mg ceftriaxone .

In shared apartments or families with unvaccinated children under 4 years of age or with immunosuppressed children, rifampicin can be given as a prophylaxis (daily single dose of 20 mg / kg body weight over four days). While small children under one month of age are protected by the nest protection , adults can alternatively receive a single dose of 500 mg ciprofloxacin .

Reporting requirement

When the excitation Haemophilus influenzae detected directly via the blood or Liquortest, this is in Germany a notifiable according to § 7 paragraph 1, no. 18 of infection Protection Act (IfSG). The management of a community facility (e.g. in a kindergarten ) must inform the health department in the event of hib meningitis or a suspected case in accordance with Section 34 IfSG. This facility must not be visited until the contagiousness has ended. Finally, the occurrence or suspicion of hib meningitis in a shared apartment must also be reported in accordance with Section 34 IfSG Paragraph 3.

In Switzerland , laboratory -analytical findings of invasive Haemophilus influenzae disease are notifiable for doctors, hospitals, etc. according to the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and Appendix 1 of the EDI Ordinance on the reporting of observations Diseases of man .

In Austria , both Haemophilus influenzae meningitis and all invasive influenzae diseases are notifiable as invasive bacterial diseases (meningitis and sepsis) . According to Section 1, Paragraph 1, Number 2, Epidemic Act 1950, this relates to cases of illness and death.

vaccination

Following the introduction of universal vaccination for children in the early 1990s, a dramatic decrease in the number of cases of Haemophilus influenzae type b infections was observed worldwide. In the United States, for example, the incidence fell from over 80 to 0.5 per 100,000 among children under five. As a result, increases have been recorded among vaccinated children and adolescents in the UK and the Netherlands. In 2018, 851 cases of invasive infections caused by Haemophilus influenzae were reported in Germany, 40 of them in children up to the age of 5 and 646 in adults over 59 years. 36 of the reported cases could again be clearly assigned to capsule type b. It is important to vaccinate children as early as possible according to official recommendations, because infants are the most vulnerable group.

Usually combination vaccines are used, which contain the Hib component as a part. Vaccination reactions such as a slight increase in temperature or redness and swelling at the injection site are occasionally reported. In general, these reactions are a little more common after the second and third vaccinations. The vaccination is directed against serotype b, it shows no effect against other serotypes or unencapsulated strains.

All patients without a spleen (e.g. after a splenectomy ) or with certain diseases that impair the function of the spleen (functional asplenia ) should also be vaccinated .

Web links

Individual evidence

  1. ↑ a b c d e f g h Herbert Hof and Rüdiger Dörries: Medical Microbiology . 5th edition. Thieme, Stuttgart 2014, ISBN 978-3-13-152965-7 , pp. 426-428 .
  2. ↑ a b c d e f Ulrich Heininger: Haemophilus influenzae type b . In: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg (Eds.): Impfkompendium . 8th edition. Georg Thieme Verlag, 2015, ISBN 978-3-13-498908-3 , p. 174 .
  3. ↑ a b c d e Thiên-Trí Lâm and Ulrich Vogel: Haemophilus . In: Sebastian Suerbaum, Gerd-Dieter Burchard, Stefan HE Kaufmann, Thomas F. Schulz (eds.): Medical microbiology and infectious diseases . Springer-Verlag, 2016, ISBN 978-3-662-48678-8 , pp. 284 , doi : 10.1007 / 978-3-662-48678-8_33 .
  4. ↑ a b c d Haemophilus influenzae type b Vaccination Position Paper. (PDF) In: WHO. September 2013, accessed on March 14, 2020 .
  5. ↑ James P. Watt et al .: Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates . In: Lancet (London, England) . tape 374 , no. 9693 , September 12, 2009, p. 903-911 , doi : 10.1016 / S0140-6736 (09) 61203-4 , PMID 19748399 .
  6. ^ Ulrich Heininger: Haemophilus influenzae type b . In: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg (Eds.): Impfkompendium . 8th edition. Georg Thieme Verlag, 2015, ISBN 978-3-13-498908-3 , p. 173 .
  7. ↑ a b c Thiên-Trí Lâm and Ulrich Vogel: Haemophilus . In: Sebastian Suerbaum, Gerd-Dieter Burchard, Stefan HE Kaufmann, Thomas F. Schulz (eds.): Medical microbiology and infectious diseases . Springer-Verlag, 2016, ISBN 978-3-662-48678-8 , pp. 285 , doi : 10.1007 / 978-3-662-48678-8_33 .
  8. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , pp. 320 and 322.
  9. ^ Ulrich Heininger: Haemophilus influenzae type b . In: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg (Eds.): Impfkompendium . 8th edition. Georg Thieme Verlag, 2015, ISBN 978-3-13-498908-3 , p. 176 .
  10. ↑ a b Ulrich Heininger: Haemophilus influenzae type b . In: Heinz Spiess, Ulrich Heininger, Wolfgang Jilg (Eds.): Impfkompendium . 8th edition. Georg Thieme Verlag, 2015, ISBN 978-3-13-498908-3 , p. 177 .
  11. ↑ Legal basis and reporting of communicable diseases. Federal Ministry for Social Affairs, Health, Care and Consumer Protection , October 7, 2019, accessed on March 14, 2020 .
  12. ^ National Reference Center for Haemophilus. AGES , October 22, 2019, accessed on March 14, 2020 .
  13. ↑ Astrid Milde-Busch et al .: Surveillance for rare infectious diseases: is one passive data source enough for Haemophilus influenzae? In: European Journal of Public Health . Vol. 18, No. 4, 2008, pp. 371–375, ISSN  1101-1262 ( PDF; 98 kB )
  14. ↑ Infection epidemiological yearbook of reportable diseases for 2018. RKI, March 1, 2019, pp. 98-102 , accessed on March 14, 2020 .
  15. ↑ Robert Koch Institute : Recommendations of the Standing Vaccination Commission (STIKO) at the Robert Koch Institute / Status: August 2019 In: Epidemiologisches Bulletin . August 22, 2019 / No. 3, p. 225, ISSN  1430-0265 ( PDF; 945 kB )
  16. ↑ Safety of vaccinations. Robert Koch Institute, December 2, 2010, accessed November 23, 2012 .
  17. ↑ Vaccinations for asplenia (removal of the spleen or loss of organ function). (No longer available online.) Robert Koch Institute, September 11, 2012, archived from the original on June 18, 2012 ; Retrieved November 23, 2012 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.rki.de