Klibanov Olga M, Kehr Heather, Jeter Zanesha, Ekwonu Tabugbo
IQVIA, Medical and Patient Communications, Pasippany, NJ, USA.
Wingate University, Wingate, NC, USA.
J Med Cases. 2022 Aug;13(8):396-401. doi: 10.14740/jmc3974. Epub 2022 Aug 19.
The rates of nontypeable (NTHi) invasive disease have been increasing since the introduction of the type b (Hib) vaccine, but its significance in adults is unclear. A 33-year-old man with human immunodeficiency virus (HIV) was admitted for fever and acute confusion. The day prior to admission he presented to another emergency department for nausea, vomiting and diarrhea where he was thought to have food poisoning and was sent home. Ten days prior to admission, his primary physician thought his nasopharyngitis symptoms were due to the common cold. The patient's HIV had been controlled on antiretroviral therapy for the past 3 years; 1 month prior to admission his viral load was undetectable. Laboratory evaluation on admission was significant for elevated lactic acid and CD4 cell count of less than 200. A head computed tomography (CT) was unremarkable, but a lumbar puncture was consistent with bacterial meningitis. was suspected and the patient was placed on empiric antibiotics. Shortly after admission the patient was intubated and suffered a cardiac arrest. The patient was placed on vasopressor support after circulation returned; a repeat head CT showed increased swelling of his brain. An electroencephalogram (EEG) indicated complete suppression of activity and the patient expired on day 2 of hospitalization. After the patient's death, cerebrospinal fluid (CSF) cultures reported as positive for () and sent to the state lab where it was further classified as NTHi, biotype I. NTHi strains can cause invasive disease in adults and should be considered as a potential pathogen for meningitis and bacteremia.
自b型流感嗜血杆菌（Hib）疫苗引入以来，不可分型流感嗜血杆菌（NTHi）侵袭性疾病的发病率一直在上升，但其在成人中的意义尚不清楚。一名33岁的人类免疫缺陷病毒（HIV）感染者因发热和急性意识模糊入院。入院前一天，他因恶心、呕吐和腹泻前往另一家急诊科就诊，当时被认为是食物中毒，随后被送回家。入院前十天，他的初级医生认为他的鼻咽炎症状是由普通感冒引起的。该患者的HIV在过去3年中通过抗逆转录病毒疗法得到了控制；入院前1个月，其病毒载量检测不到。入院时的实验室检查显示乳酸升高，CD4细胞计数低于200。头部计算机断层扫描（CT）无异常，但腰椎穿刺结果符合细菌性脑膜炎。怀疑为[未提及具体病菌名称]，患者开始接受经验性抗生素治疗。入院后不久，患者插管并发生心脏骤停。循环恢复后，患者接受了血管升压药支持治疗；再次进行的头部CT显示脑部肿胀加剧。脑电图（EEG）显示活动完全抑制，患者在住院第2天死亡。患者死亡后，脑脊液（CSF）培养报告为[未提及具体病菌名称]阳性，并送往州实验室，在那里进一步分类为生物I型NTHi。NTHi菌株可导致成人侵袭性疾病，应被视为脑膜炎和菌血症的潜在病原体。
