Haemophilus influenzaeinfection of a prosthetic knee joint in a patient with CLL: a vaccine preventable disease

Abstract

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 grewHaemophilus 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.

Invasive Haemophilus influenzae Infection in Patients with Cancer

“…5,17 Although upper respiratory infection was the most common presentation in our cases (> 50%), other organ systems have also been involved. 1,2,4,21 In other published reports, the primary focus of infection is not always recognized.…”

“…5,11 In addition to the changes in the serotype distribution of H influenzae infections, widespread childhood immunization has shifted the trend of infection toward elderly persons with comorbidities. 5,6,11,12,17,21 Common factors include cancers and other immunocompromised states, and this is especially true where humoral immunity is compromised. MM is the major malignancy among them.…”

“…Of the 17 cases found in the literature, 14 were reported to have a full resolution of their infection after prompt treatment; the 3 other patients were elderly (≥ 63 years). 4,12,[15][16][17][18][19][20] Because widespread childhood immunization has shifted the trend of infections in the United States toward elderly patients with comorbidities, and because the case fatality rate of these invasive infections increases with age, it is important that we develop preventive and treatment options designed for the elderly population. …”

“…Based on these criteria, we identified 9 of the original 129 articles for inclusion in this review. 4,12,[15][16][17][18][19][20] In the studies reviewed, the age of the case patients ranged from 30 to 77 years; their mean age was 63.1 years (Table). 4,12,[15][16][17][18][19][20] Eleven men and 6 women made up the cases.…”

“…None of the case patients had neutropenia. 4,12,[15][16][17][18][19][20] Seven patients had leukocytosis and 3 had lymphopenia.…”