Khan Sheema, Reddy Srinivasulu
Department of Microbiology, East Kent University Hospital NHS Foundation Trust, Ashford, UK.
BMJ Case Rep. 2013 Nov 19;2013:bcr2013010307. doi: 10.1136/bcr-2013-010307.
A 71-year-old man was admitted with a 2-day history of the hot and swollen right knee in December 2012. He had undergone a primary cemented right total knee replacement (TKR) in 2002. He also had a history of chronic lymphatic leukaemia (CLL), haemolytic anaemia and splenomegaly, and was in partial remission following chemotherapy in 2008. He underwent arthroscopic washout of right TKR on admission. Blood cultures on admission and joint fluid specimen grew Haemophilus influenzae (Hi). The isolate was identified as a non-encapsulated Hi strain by the reference laboratory. Non-encapsulated Hi strains rarely cause invasive disease. CLL with splenomegaly may have predisposed our patient to severe invasive disease. A recently licensed 10-valent pneumococcal vaccine conjugated to the immunogenic outer membrane protein D of Hi could potentially prevent invasive Hi disease. Routine vaccination should be considered in all patients with prosthetic joints and predisposing comorbidities.
一名71岁男性于2012年12月因右膝红肿热痛2天入院。他在2002年接受了初次骨水泥固定右全膝关节置换术（TKR）。他还有慢性淋巴细胞白血病（CLL）、溶血性贫血和脾肿大病史，并在2008年化疗后处于部分缓解状态。入院时他接受了右TKR关节镜冲洗术。入院时血培养及关节液标本培养出流感嗜血杆菌（Hi）。参考实验室将分离株鉴定为非包膜Hi菌株。非包膜Hi菌株很少引起侵袭性疾病。伴有脾肿大的CLL可能使我们的患者易患严重侵袭性疾病。一种最近获批的与Hi具有免疫原性的外膜蛋白D结合的10价肺炎球菌疫苗可能预防侵袭性Hi疾病。对于所有有假体关节和易感合并症的患者应考虑常规接种疫苗。
