Necrotizing Fasciitis Caused by Haemophilus influenzae Serotype f

Abstract

cHaemophilus influenzae is a rare cause of soft tissue infection. In this report, we present a case of multifocal necrotizing fasciitis in a healthy adult patient, secondary to Haemophilus influenzae serotype f infection, and we review literature on this rare cause of necrotizing fasciitis. CASE REPORTA 63-year-old female came to the Duke University Medical Center Emergency Department in February 2013 because of a fever and increasing right hip and right shoulder pain that had occurred over a 5-day period. Her medical history was notable for stage II breast cancer treated with a left mastectomy and six cycles of cyclophosphamide and adriamycin in 1996 and for hypothyroidism, mitral valve prolapse, and hyperlipidemia.Several days prior to hospitalization, the patient had cared for a grandchild with a mild upper respiratory illness. Two days later, the patient noted mild throat discomfort. The following day, she went on a 4-mile run and then did yoga and weight training. Later that day, chills occurred. Her temperature rose to 104°F, and she took ibuprofen. The next morning, she noted pains in her right groin and right shoulder and sought evaluation at a local emergency department. Results of basic laboratory testing and a nasal swab for influenza virus were normal or negative; thus, she was discharged without a specific diagnosis and with instructions to take analgesics and rest. The following day, her right shoulder and groin pain were worse. She was seen in the office of an orthopedic surgeon, who prescribed methyl prednisolone. Her pain intensified over the next 2 days, and thus, she went to the Emergency Department at Duke University Medical Center, where an examination showed a normal temperature and blood pressure. Passive and active movements of her right shoulder and right hip were limited by pain. The soft tissues overlying the right shoulder from the deltoid to the midhumerus and from the region of the pubic symphysis to the right medial thigh were indurated and erythematous. Initial laboratory tests showed the following: C-reactive protein (CRP) level, 37.6 mg/dl; erythrocyte sedimentation rate (ESR), 91 mm/h; creatinine level, 2.7 mg/dl; platelet count, 110 ϫ 10 9 cells/liter; white blood cell count, 2.4 ϫ 10 9 cells/liter (36% bands); aspartate transaminase (AST) level, 48 U/liter; and creatinine kinase level, 195 U/liter (30 to 220 U/liter). Blood and urine specimens were obtained for cultures, and treatment with vancomycin and ceftriaxone was initiated.Following admission, ceftriaxone was discontinued, and treatment with clindamycin and cefepime was begun. A consulting orthopedic surgeon attempted to aspirate the right shoulder, but no joint fluid could be detected. Aspiration of the right hip recovered a small amount of fluid containing 83 white blood cells/l (44% polymorphonuclear cells); no organisms were seen on the Gram stain. A subsequent magnetic resonance imaging study revealed findings consistent with nonspecific myositis and fasciitis involving the right shoulder and arm and right hip and...

<i>Haemophilus influenzae</i> Non-type b Infection in an Adult Patient with Systemic Lupus Erythematosus

“…Previous reports indicated that comorbid diseases, such as chronic obstructive pulmonary disease, malignancy, and immunosuppression, are risk factors for invasive infections caused by H. influenzae (3). To compare this case with the trend in recent invasive Hif infections, the authors surveyed case reports on PubMed using the search terms "H. influenzae type f" and "adult" and used the results to build a summary table (Table 4) of case report of invasive Hif infections since 2013, when routine immunization against Hib started in Japan (18)(19)(20)(21)(22)(23)(24). In these cases, the median age was 63 years old, with some differences in sex.…”

Severe Presentation of NontypeableHaemophilus influenzae(NTHi) Infection in a Previously Healthy Toddler

“…Moreover, the Haemophilus bacterium can also survive in the respiratory epithelial cells which is called intracellular sequestration, which might explain not only its colonization in the respiratory tract epithelium but also that it can migrate below the cells through transmural migration to the subepithelial area and get access to the vascular system, resulting in severe invasive infections like bacteremia and meningitis [4]. Another factor described by Arnold et al is the ability of NTHi to form microcolonies on its mucosal surfaces which can inhibit the function of the secreted bacteriostatic products such as lactoferrin and lysozymes and to some potential can inhibit the antibody production [12].…”

First Necrotizing Fasciitis Caused by Haemophilus influenza Serotype a

“…Most of the patients in previous cases of H influenza NF had underlying comorbidities such as immunosuppression, malignancy, and diabetes. 6 , 7 In the study by Azar et al, the patient had a documented case of hypocomplementemia along with immunosuppressants for auto-immune diseases. Complement and immunoglobulin opsonization play a major role in fighting encapsulated bacteria.…”

“…As before, no soft-tissue infections were reported in this case. 5 There have only been 13 documented cases of NF caused by H influenza serotypes b, f, and e. 6,7 This is the first documented case of H influenza type a causing NF, so it is unclear why one serotype was found over another. Most of the patients in previous cases of H influenza NF had underlying comorbidities such as immunosuppression, malignancy, and diabetes.…”