Hirschmann J V, Everett E D
Medicine (Baltimore). 1979 Jan;58(1):80-94. doi: 10.1097/00005792-197901000-00005.
Haemophilus influenzae is an aerobic pleomorphic gram-negative coccobacillus that requires both X and V factors for growth. It grows poorly, if at all, on ordinary blood agar unless streaked with Staph. aureus. It grows well on chocolate agar. Because this medium is often not used in culturing specimens from adults and because the organism may be overgrown by other bacteria, the frequency of H. influenzae infections has undoubtedly been seriously underestimated. This is aggravated by the failure of many physicians to obtain blood cultures in suspected bacterial infections and the failure of many laboratories to subculture them routinely onto chocolate agar. H. influenzae, along with Streptococcus pneumoniae, is a major factor in acute sinusitis. It is probably the most frequent etiologic agent of acute epiglottitis. It is probably a common, but commonly unrecognized, cause of bacterial pneumonia, where it has a distinctive appearance on Gram stain. It is unusual in adult meningitis, but should particularly be considered in alcoholics; in those with recent or remote head trauma, especially with cerebrospinal fluid rhinorrhea; in patients with splenectomies and those with primary or secondary hypogammaglobulinemia. It may rarely cause a wide variety of other infections in adults, including purulent pericarditis, endocarditis, septic arthritis, obstetrical and gynecologic infections, urinary and biliary tract infections, and cellulitis. Antimicrobial susceptibility testing is somewhat capricious in part from the marked effect of inoculum size in some circumstances. In vitro and in vivo results support the use of ampicillin, unless the organism produces beta-lactamase. Alternatives in minor infections include tetracycline, erythromycin, and sulfamethoxazole-trimethoprim. For serious infections chloramphenicol is the best choice if the organism is ampicillin-resistant or the patient is penicillin-allergic.
流感嗜血杆菌是一种需氧的多形性革兰氏阴性球杆菌，生长需要X因子和V因子。在普通血琼脂上生长不佳，除非与金黄色葡萄球菌交叉划线。在巧克力琼脂上生长良好。由于这种培养基在培养成人标本时通常不使用，且该菌可能被其他细菌过度生长，流感嗜血杆菌感染的频率无疑被严重低估了。许多医生在疑似细菌感染时未进行血培养，许多实验室也未常规将其转种到巧克力琼脂上，这使得情况更加严重。流感嗜血杆菌与肺炎链球菌一样，是急性鼻窦炎的主要因素。它可能是急性会厌炎最常见的病原体。它可能是细菌性肺炎常见但通常未被认识的病因，在革兰氏染色中有独特表现。在成人脑膜炎中不常见，但在酗酒者中应特别考虑；在近期或远期有头部外伤的患者中，尤其是有脑脊液鼻漏的患者；在脾切除患者以及原发性或继发性低丙种球蛋白血症患者中。它在成人中很少引起多种其他感染，包括脓性心包炎、心内膜炎、化脓性关节炎、妇产科感染、泌尿道和胆道感染以及蜂窝织炎。抗菌药敏试验在某种程度上有些变幻莫测，部分原因是在某些情况下接种量有显著影响。体外和体内结果支持使用氨苄西林，除非该菌产生β-内酰胺酶。轻度感染的替代药物包括四环素、红霉素和磺胺甲恶唑-甲氧苄啶。对于严重感染，如果该菌对氨苄西林耐药或患者对青霉素过敏，氯霉素是最佳选择。
