Hori Koichiro, Arai Riku, Kuwana Tsukasa, Kohei Agune, Kojima Keisuke, Tanaka Masashi, Okumura Yasuo
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan.
Infect Drug Resist. 2025 Jun 28;18:3199-3205. doi: 10.2147/IDR.S530643. eCollection 2025.
Haemophilus influenzae (H. influenzae) is a common commensal bacterium of the upper respiratory tract, with nontypeable H. influenzae (NTHi) increasingly recognized as a cause of invasive infections. Although purulent pericarditis itself is a rare but life-threatening condition, cases caused by NTHi are exceptionally rare, with only a few reported worldwide.
We report a case of a 63-year-old immunocompromised woman with a history of hematologic malignancy and prior Hib vaccination who developed NTHi-associated purulent pericarditis and septic shock. She initially presented with dyspnea and fever and was found to have cardiac tamponade requiring emergency pericardiocentesis. Despite initial improvement, she deteriorated with septic shock and severe pneumonia, necessitating mechanical ventilation. Blood and pericardial fluid cultures confirmed NTHi infection. Given persistent systemic inflammation and high risk of constrictive pericarditis, she underwent surgical pericardiectomy, which led to clinical recovery and successful discharge.
NTHi as a causative agent is exceedingly uncommon, with very few cases reported in the literature. The increasing incidence of invasive NTHi infections highlights the need for greater clinical awareness, particularly in immunocompromised patients. Pyogenic pericarditis has a high mortality rate, requiring prompt diagnosis and intervention. Our case supports prior observations that H. influenzae-associated pericarditis may be unresponsive to drainage alone, with pericardiectomy playing a critical role in infection control and prevention of constrictive pericarditis. This case underscores the importance of early recognition of invasive NTHi infections and highlights the potential necessity of early surgical intervention in H. influenzae-associated purulent pericarditis. Clinicians should consider H. influenzae as a causative agent in bacterial pericarditis and recognize the need for early, aggressive management to optimize patient outcomes.
流感嗜血杆菌是上呼吸道常见的共生细菌，非分型流感嗜血杆菌（NTHi）越来越被认为是侵袭性感染的病因。虽然化脓性心包炎本身是一种罕见但危及生命的疾病，但由NTHi引起的病例极为罕见，全球仅报道了少数几例。
我们报告一例63岁免疫功能低下的女性，有血液系统恶性肿瘤病史且之前接种过b型流感嗜血杆菌疫苗，她发生了NTHi相关的化脓性心包炎和感染性休克。她最初表现为呼吸困难和发热，被发现有心脏压塞，需要紧急心包穿刺术。尽管最初有所改善，但她因感染性休克和严重肺炎病情恶化，需要机械通气。血液和心包液培养证实为NTHi感染。鉴于持续的全身炎症和缩窄性心包炎的高风险，她接受了心包切除术，术后临床康复并成功出院。
NTHi作为病原体极为罕见，文献报道的病例很少。侵袭性NTHi感染发病率的增加凸显了提高临床认识的必要性，尤其是在免疫功能低下的患者中。化脓性心包炎死亡率高，需要及时诊断和干预。我们的病例支持先前的观察结果，即流感嗜血杆菌相关性心包炎可能仅靠引流无效，心包切除术在控制感染和预防缩窄性心包炎方面起着关键作用。该病例强调了早期识别侵袭性NTHi感染的重要性，并突出了在流感嗜血杆菌相关性化脓性心包炎中早期手术干预的潜在必要性。临床医生应将流感嗜血杆菌视为细菌性心包炎的病原体，并认识到需要早期积极治疗以优化患者预后。
