Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
BMC Infect Dis. 2019 Nov 8;19(1):947. doi: 10.1186/s12879-019-4572-4.
In the pre-vaccine era, invasive disease with Haemophilus influenzae, type b (Hib) commonly presented with osteoarticular involvement. Haemophilus influenzae, type a (Hia) sepsis is a rare but emerging problem in recent years. Here, we report a case of sepsis with concomitant osteoarthritis due to Hia that was the presenting infectious disease manifestation of isolated asplenia in a young child. This unique observation adds to our understanding of sepsis and asplenia in children.
A five-year-old girl developed acute Hia bacteremia and sepsis. The patient developed arthritis shortly after onset of septic shock. Arthrocentesis was culture-negative, but given the difficulty differentiating between septic and reactive arthritis, prolonged antibiotic administration was provided for presumed osteoarticular infection, and the patient had an uneventful recovery. The finding of Howell-Jolly bodies on blood smear at the time of presentation prompted an evaluation that revealed isolated congenital asplenia. Evaluation for known genetic causes of asplenia was unrevealing. Investigation by the Minnesota Department of Health revealed an emergence of Hia infections over the past 5 years, particularly in children with an American Indian background.
Hia is an important pathogen in the differential diagnosis of invasive bacterial infections in children and shares overlap in clinical presentation and pathogenesis with Hib. Invasive Hia disease can be a presenting manifestation of asplenia in children. Hia is an emerging pathogen in American Indian children.
在疫苗接种前时代，侵袭性疾病流感嗜血杆菌 b 型（Hib）通常表现为骨关节受累。近年来，甲型流感嗜血杆菌（Hia）败血症是一种罕见但日益出现的问题。在此，我们报告了一例由 Hia 引起的败血症合并骨关节炎的病例，该病例是小儿孤立性脾切除的首发感染性疾病表现。这一独特的观察结果增加了我们对儿童败血症和脾切除的认识。
一名 5 岁女孩发生急性 Hia 菌血症和败血症。患者在发生感染性休克后不久出现关节炎。关节穿刺术培养阴性，但鉴于难以区分败血症性和反应性关节炎，给予了延长抗生素治疗以推测骨关节感染，并进行了顺利的康复。在出现时的血涂片上发现 Howell-Jolly 小体，促使进行评估，结果显示为孤立性先天性脾切除。对已知脾切除遗传原因的评估未发现异常。明尼苏达州卫生部的调查显示，过去 5 年来 Hia 感染有所增加，特别是在具有美洲印第安人背景的儿童中。
Hia 是儿童侵袭性细菌感染鉴别诊断中的重要病原体，其临床表现和发病机制与 Hib 重叠。侵袭性 Hia 疾病可能是儿童脾切除的首发表现。Hia 是美洲印第安儿童中的新兴病原体。
