Haemophilus influenzae infection

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Haemophilus influenzae (formerly called Pfeiffer's bacillus or Bacillus influenzae) is a bacteria, not a virus despite its name.  It was first described in 1892 by Richard Pfeiffer during an influenza pandemic and was mistakenly considered to be the cause of influenza until 1933, when the viral etiology of influenza became apparent.
It is a Gram-negative, coccobacillary, facultatively anaerobic pathogenic bacterium belonging to the Pasteurellaceae family and the Genus: Haemophilus.

Haemophilus genus of bacteria

The Haemophilus genus of bacteria inhabit the mucous membranes of the upper respiratory tract, mouth, vagina, and intestinal tract. This genus has also been found to be part of the salivary microbiome.  The genus not only includes organisms showing commensalism with humans, but includes some significant pathogenic species such as H. ducreyi, the causative agent of chancroid. All members are either aerobic or facultatively anaerobic.   

H. influenza strains

H. influenzae may be either encapsulated (typeable) or unencapsulated (nontypeable).

• Encapsulated strains are classified on the basis of their distinct capsular antigens. Six antigenically distinct capsular types of H. influenzae  -known as types a, b, c, d, e, and f -  have been identified.   These are often referred to as strains eg Haemophilus influenzae type b strain (Hib). 
• The unencapsulated strains -  Genetic diversity among unencapsulated strains is greater than within the encapsulated group. Unencapsulated strains are termed nontypable (NTHi) because they lack capsular serotypes.

Vaccines and antibiotics

Vaccines - A vaccine for Haemophilus influenzae Type B has been available since the early 1990s, and is usually given to children under age 5 in developed countries and asplenic patients [absence of normal spleen function].  Vaccination with Hib conjugate vaccine is intended to prevent Hib infection, but does not prevent infection with NTHi strains.  Unencapsulated H. influenzae strains are unaffected by the Hib vaccine, as are all other encapsulated strains.

Antibiotics - Haemophilus influenzae produces beta-lactamases, and it is also able to modify its penicillin-binding proteins, so it has gained resistance to the penicillin family of antibiotics. Many cases are diagnosed after presenting chest infections do not respond to penicillins or first-generation cephalosporins.  Fluoroquinolone-resistant Haemophilus influenzae has been observed.  Resistance to Macrolide antibiotics (e.g., clarithromycin) has also been observed.  Resistance to trimethoprim-sulfamethoxazole (SXT) has been found.

Many nontypeable strains are resistant, this is just one study in Korea

Strains were also resistant to cefuroxime, cefpodoxime, and cefixime;  

Symptoms and diagnosis

Initial symptoms are usually those of an upper respiratory tract infection mimicking a viral infection, usually associated with a temperature, often low-grade. This may progress to the lower respiratory tract in a few days, with features often resembling those of a wheezy bronchitis. Sputum may be difficult to expectorate and is often grey or creamy in colour. 

Most strains of H. influenzae are under normal circumstances not pathogenic; that is, they usually live in their host without causing disease, but cause problems only when other factors - such as

• reduced immune function
• chronically inflamed tissues, e.g. from allergies

create an opportunity.  

In both cases one can see that the immune system and its state is key, as chronically inflamed tissues usually indicate an attack by toxins or pathogens and a severely strained immune system would also be the consequence of other pathogenic attack from for example viruses.  In general therefore these bacteria only become pathogenic when the immune system has been suppressed, compromised or is under significant pressure.

For this reason, clinical diagnosis of apparent H. influenza infection is only considered confirmed when the organism is isolated from a sterile body site. In this respect, H. influenzae cultured from the nasopharyngeal cavity or sputum would not indicate H. influenzae disease, because these sites are colonized in disease-free individuals. However, H. influenzae isolated from cerebrospinal fluid or blood would indicate H. influenzae infection.

Furthermore, use of antibiotics prior to sample collection greatly reduces the ability to diagnose which strain of the bacteria or even the bacteria itself is causing the infection, as it may kill the bacteria in the sample selected before identification is possible. This has relevance, as the bacteria may still be present in other sites.  Beyond this, H. influenzae is a finicky bacterium to culture, and any modification of culture procedures can greatly reduce isolation rates.

In the following it is important to note which strain is causing the infection as the vaccine available is strain specific.  Remember that a vaccine is only available for Haemophilus influenzae Type B, and all the strains are very quickly becoming antibiotic resistant.

Sinusitis, COPD,: acute otitis media

Bronchitis

Bacteremia or sepsis

Septic arthritis

Pericarditis

This example shows that not only H. infleunzae can cause pericarditis, but other members of the Haemophilus genus can

Cellulitis

Orbital cellulitis is inflammation of eye tissues behind the orbital septum. It is most commonly caused by an acute spread of infection into the eye socket from either the adjacent sinuses or through the blood.  The implications here are that the vaccine introduced the bacteria into the blood and caused the cellulitis:

Pneumonia

Bacteria are the most common cause of community acquired pneumonia with Streptococcus pneumoniae isolated in nearly 50% of cases.  Other commonly isolated bacteria include: Haemophilus influenzae in 20%, Chlamydophila pneumoniae in 13%, , and Mycoplasma pneumoniae in 3%.

Stroke

The Haemophilus influenzae bacteria is implicated in causing strokes.....

Osteomyelitis

Osteomyelitis or OM -  is infection and inflammation of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism - pyogenic bacteria or mycobacteria -  and the route, duration and anatomic location of the infection.  For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation

Endometritis

Premature birth, Miscarriages and stillbirths

There are a great number of bacteria that can attack both the mother and fetus in the womb.  For example

Meningitis

Several types of bacteria can cause meningitis.   In premature babies and newborns up to three months old, common causes are  group B streptococci, Escherichia coli and  Listeria monocytogenes. Older children are more commonly affected by Neisseria meningitidis (meningococcus), and Streptococcus pneumoniae .  And those under five by Haemophilus influenzae type B.  

Conjunctivitis

Common bacteria responsible for non-acute bacterial conjunctivitis are Staphylococci and Streptococci.  Bacteria such as Chlamydia trachomatis or Moraxella can also cause persistent conjunctivitis without much redness. Other cases of bacterial conjunctivitis are associated with Neisseria gonorrhoeae, β-hemolytic streptococci, Corynebacterium diphtheria, Haemophilus influenzae.  Hyperacute cases are usually caused by Neisseria gonorrhoeae or N. meningitidis.

Urinary tract infection

Urogenital infection

Causes

We saw that the immune system and its state is key, as to the whether these bacteria become pathogenic.  In general these bacteria only become pathogenic when the immune system has been suppressed, compromised or is under significant pressure.

Significant co-morbidity

Vaccines - overload

The DTaP-IPV-Hib vaccination contains Diphtheria, Tetanus, Acellular Pertussis, Inactivated Poliovirus, and Haemophilus Influenzae Type b.  It has already been “associated with an increased risk of febrile seizures on the day of the first 2 vaccinations given at 3 and 5 months."  This vaccine also contains aluminium – see list below.   Aluminium is known to destroy the blood brain barrier.  In this case we have a vaccine that would put the immune system under significant pressure.

Vaccines and Epiglottitis

An exceptionally important rider needs to be added to this paragraph.  Both H. influenzae and S. pneumoniae can be found in the upper respiratory system of humans. When both bacteria are placed together into a nasal cavity, within 2 weeks, only H. influenzae survives. When either is placed separately into a nasal cavity, each one survives. Upon examining the upper respiratory tissue from mice exposed to both bacteria species, an extraordinarily large number of neutrophils (immune cells) was found. In mice exposed to only one bacterium, the cells were not present.

Lab tests showed neutrophils exposed to dead H. influenzae were more aggressive in attacking S. pneumoniae than unexposed neutrophils.  It is the combination of the two species that triggers an immune system response that is not set off by either species individually.

By vaccinating anyone against H. influenza, we have thus ensured that our immune system no longer works – it has been compromised.

Immunosuppressants

The standard form of treatment for diseases classified as ‘auto-immune’ is to provide various forms of immunosuppressants.  Immunosuppressants suppress the immune system.   By doing so the actual pathogen causing the disease spreads and it can go all over the body.  Haemophilus Influenzae bacteria are just one type of bacteria amongst many that become pathogenic when immunosuppressants are used to suppress symptoms.

Medicine is almost entirely based currently on symptom suppression, not in addressing the cause.  By classifying any disease as auto-immune, - the immune system apparently attacking the body, -the medical profession have ignored any suggestion that a pathogen or toxin may be responsible.

Hydroxychloroquine is used as an immunosuppressant  to “reduce inflammation in the treatment of rheumatoid arthritis and lupus”.  Bisphosphonates are immunosuppressants used to treat osteoporosis.

Iatrogenic illness is disease caused by the diagnosis, manner, or treatment of a physician.  It may result from medical errors, such as mistakes made in surgery, or the prescription or dispensing of the wrong therapy, such as a drug.

Hospital equipment

Please note that there are other examples of hospitals themselves being the source of infection

Surgery

Treatment

Address the cause

References and further reading

• Semin Respir Infect. 2000 Mar;15(1):41-51.  Haemophilus influenzae in chronic bronchitis.  Murphy TF1.  1 Department of Medicine, State University of New York at Buffalo, NY, USA.
• Open Microbiol J. 2018 Jul 31;12:243-247. doi: 10.2174/1874285801812010243. eCollection 2018. Nontypable Haemophilus influenzae Septicemia and Urinary Tract Infection Associated with Renal Stone Disease. Stærk M1, Tolouee SA2, Christensen JJ1,3.
• Open Forum Infect Dis. 2018 Jun 26;5(7):ofy146. doi: 10.1093/ofid/ofy146. eCollection 2018 Jul.  Breech at the Border: An Atypical Case of Invasive Haemophilus influenzae in a Patient on a Novel Immunotherapeutic.  Howard-Anderson J1, Satola SW1,2, Collins MH1.
• Risk of Febrile Seizures and Epilepsy After Vaccination With Diphtheria, Tetanus, Acellular Pertussis, Inactivated Poliovirus, and Haemophilus Influenzae Type b JAMA 2012, Yuelian Sun, Jakob Christensen, Anders Hviid, Jiong Li
• Diagn Microbiol Infect Dis. 2013 Jun;76(2):235-6. doi: 10.1016/j.diagmicrobio.2013.02.010. Epub 2013 Mar 26.  Haemophilus influenzae acute endometritis with bacteremia: case report and literature review.  Martin D1, Dbouk RH, Deleon-Carnes M, del Rio C, Guarner J.
• Pelvic abscess associated with Haemophilus influenzae bacteremia.  Guerrier G, Morisse L, Perrin D.  Int J Gynaecol Obstet. 2009 Nov;107(2):152-3. doi: 10.1016/j.ijgo.2009.06.004. Epub 2009 Jul 7. No abstract available.   PMID:  19586626
• Haemophilus influenzae type e meningitis and bacteremia in a healthy adult. -Al-Tawfiq JA. Intern Med. 2007;46(4):195-8. Epub 2007 Feb 15. Review. PMID: 17301516
• Transient Haemophilus influenzae type b bacteremia in a healthy child.  Matsuda K, Sakata Y, Tani H, Kimura K, Matsuishi T.  Kurume Med J. 2005;52(1-2):53-6.  PMID: 16119613
• Biliary infection and bacteremia caused by beta-lactamase-positive, ampicillin-resistant Haemophilus influenzae in a diabetic patient.  Oksuz S, Ozturk E, Sahin I, Ertor O, Kaya D.  Jpn J Infect Dis. 2005 Feb;58(1):34-5.  PMID:  15728989
• Clin Pract Cases Emerg Med. 2018 Oct 16;2(4):338-340. doi: 10.5811/cpcem.2018.9.39280. eCollection 2018 Nov.  Acute Epiglottitis with Concurrent Pneumonia and Septic Shock in an Alcoholic Adult Patient.  Chitty A1, Taylor K1.
• IDCases. 2017 Jun 27;9:79-81. doi: 10.1016/j.idcr.2017.06.008. eCollection 2017.  Haemophilus influenzae serotype f endocarditis and septic arthritis.  Oikonomou K1, Alhaddad B1, Kelly K1, Rajmane R1, Apergis G1.

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