Haemophilus influenzae infection
H. influenzae on a blood agar plate.
(Lehmann & Neumann 1896)
Winslow et al. 1917
Haemophilus influenzae infection Main page
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Editor-In-Chief: C. Michael Gibson, M.S., M.D.  ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. 
Synonyms and keywords: Hib disease
H.influenzae is a gram-negative, cocco-bacillary, facultatively anaerobic pathogenic bacterium that can cause infections in people of all ages ranging from mild, such as an ear infection, to severe, such as a bloodstream infection. It is a normal commensal of nose and throat and does not cause any infection under normal situations. But when the host defense mechanisms are weakened it invades the epithelium and disseminates to other parts of the body where it causes infection.
- Haemophilus influenza infections are caused by the bacterium Haemophilus influenza.
- It is a is a gram-negative, cocco-bacillary, facultatively anaerobic bacterium.
- Based on their distinct capsular antigens they are grouped into capsular (typeable) and non-capsulate (nontypeable)
- There are six identifiable types of H.influenza (a, b, c, d, e, and f)
- H. influenza type b is the most common type among capsular H.influeza.
- These bacteria are a normal commensal of throat and nose. However, the bacteria can sometimes move to other parts of the body and cause infection.
H. influenzae, including Hib, can cause many different kinds of infections. These infections can range from mild ear infections to severe diseases, like bloodstream infections. When the bacteria invade parts of the body, like spinal fluid or blood, this is known as "invasive disease." Invasive disease is usually severe and can sometimes result in death.
The most common types of invasive disease caused by H.influenza are:
The most common types of non-invasive disease caused by H.influenza are:
|H influenza infection|
|Infection due to capsulated H influenzae(Invasive)||Infection due to non-capsulated H influenzae(Non-invasive)|
|Meningitis||Cellulitis||Epiglottitis||Pneumonia||Pericarditis||Septic arthritis||otitis media||Conjunctivitis|
- Transmission is by direct contact or by inhalation of respiratory tract droplets.
- Neonates can acquire the infection by aspiration of amniotic fluid or contact with genital tract secretions containing the bacteria.
- A larger bacterial load or the presence of a concomitant viral infection can potentiate the infection.
- The colonizing bacteria invade the mucosa and enter the bloodstream.
- The spread of bacteria by direct extension to the eustachian tubes causes otitis media.
- Spread to the sinuses leads to sinusitis.
- Spread down the respiratory tract results in bronchitis and pneumonia.
- Eustachian tube dysfunction, antecedent viral upper respiratory tract infection (URTI), foreign bodies, and mucosal irritants, including smoking, can promote infection.
- In patients with underlying chronic obstructive pulmonary disease (COPD) or cystic fibrosis (CF), non-typeable H influenza frequently colonizes the lower respiratory tract and can exacerbate the disease.
- The capsule of H influenza plays a key role in the pathogenesis of the all the capsulated H influenza infections.
- The antiphagocytic nature of the Hib capsule makes it resistant to natural host phagocytic defense mechanisms and facilitating bacterial proliferation.
- After proliferation, the bacterial load disseminates to various sites, including meninges, subcutaneous tissue, joints, pleura, pericardium, and lungs triggering an inflammatory response and subsequently activating the complement system.
- Capsulated H influenza can penetrate the normal epithelium and are therefore responsible for invasive infections.
- Non-capsulated are non-invasive but can still induce the inflammatory response similar to that of capsulated organisms
- The Hib conjugate vaccine induces protection by inducing antibodies against the PRP capsule.
- The Hib conjugate vaccine does not provide protection against Non-typable H influenza strains. Since the widespread use of the Hib conjugate vaccine, Non-typable H influenza strains has become more of a pathogen.
- "Pinkbook | Hib | Epidemiology of Vaccine Preventable Diseases | CDC".
- Duell BL, Su YC, Riesbeck K (2016). "Host-pathogen interactions of nontypeable Haemophilus influenzae: from commensal to pathogen". FEBS Lett. 590 (21): 3840–3853. doi:10.1002/1873-3468.12351. PMID 27508518.
- Close RM, Pearson C, Cohn J (2016). "Vaccine-preventable disease and the under-utilization of immunizations in complex humanitarian emergencies". Vaccine. 34 (39): 4649–55. doi:10.1016/j.vaccine.2016.08.025. PMID 27527818.