Hemophilic infection (hib infection) is caused by the hemophilic wand type B - Haemophilus Influenzae Type b. It can cause acute infectious diseases - purulent meningitis, pneumonia (inflammation of the lungs), epiglotte (inflammation of the epiglotany), arthritis (joint inflammation), as well as purulent defeat of the whole organism - sepsis. Hemophilic infection is characterized by preferably damage to the respiratory, central nervous system and the development of purulent foci in various organs. Bacterium H. INFLUENZAE. Localizes in the nasopharynx, from where it can be transmitted to other people with air-droplet. Only a very small number of those who in the nasopharynk is localized by the pathogen, the disease is developing with clinical manifestations. However, carriers H. INFLUENZAE. The nasopharynk is an important source of pathogen spread.
The probability of sick
Several risk groups are isolated for this disease. First, children are most often suffering from this infection. According to various studies, the hemophilic stick carriage in the children's team reaches 50%. In children 6-12 months. Located on artificial feeding and not receiving small additional amounts of maternal antibodies with breast milk, especially high risk of developing the most severe infection forms - inflammation of lungs and meningitis. For this reason, artificial feeding is an additional indication to vaccinate against hib infection, starting from 3 months of age.
Extreme age people (children under 2 years old, older people) and persons with low socio-economic status are also susceptible to hemophilic infection. In addition, the disease is subject to persons with low socio-economic status, extremely weakened and suffering from alcoholism, patients with lymphogranulomatosis (Hodgkin's disease), sickle cell anemia; Persons exposed splenectomy (removal of spleen).
The incidence rises at the end of winter and spring. In recent years, the incidence of adults has noticeably increased.
The duration of the incubation period is difficult, since the disease is often due to the transition of the latent infection in the manifestic. It may develop as a local inflammatory process of the mucous membrane of the upper respiratory tract and diseases caused by hematogenous dissemination.
Complications after transferred disease
Often, the hemophilic infection occurs in children in the form of a regular respiratory infection with the corresponding symptoms. However, there are no cases and more severe infection forms. The most severe form of hemophilic infection is purulent meningitis. According to some data in Russia in children up to 6 years to a third of all cases of purulent meningitis caused Haemophilus Influenzae Type B . Hemophilic meningitis is poorly treatment, since their causative agent produces enzymes that make it resistant to antibiotics (about 20-30% of hemophilic sticks isolated from patients not sensitive to many antibiotics). Therefore, the results of treatment are not always successful, and mortality in severe forms of the disease can reach 16-20%.
In a third of the patients who suffered hemophilic meningitis, irreversible neurological complications are developing - cramps, a delay in neuropsychic development, deafness, blindness, etc.
Pneumonia ,caused by hemophilic stick type B, arises mainly in children from 2 to 8 years, and its flow in 60% of cases also has various complications, including from the heart and lungs.
With hemophilic infection, up to half of all purulent ear, throat, nose, nose, in particular, recurrent purulent otites (inflammation of the middle ear) and sinusites (inflammation of the apparent sinuses of the nose) are associated with hemophilic infection.
Hemophilic sepsis more often develops in children 6-12 months., Predisposed to this disease. It proceeds violently, often as a lightning room, with septic shock and fast death of the patient.
Purulent arthritis are a consequence of hematogenic hemophilic sticks, are often accompanied by osteomyelitis.
Currently, 26-43 cases caused by hemophilic stick, per 100,000 children are registered in European countries, mortality is 1-3%, high levels of neurological complications.
Hemophilic hib infection is poorly treatment, since the hemophilic stick is recordly resistant to antibiotics. For this reason, even timely treatment with modern antibiotics is often unsuccessful. Penicillin antibiotics, erythromycin, leftomycetin, tetracycline - the percentage of hemophilic stick resistance to them is 80-100% (on the number of dedicated samples of bacteria). Without etiotropic therapy, some forms of hemophilic infection (meningitis, epiglotte) almost always end with the death of the patient. It is necessary to begin treatment as soon as possible from hemophilic infection.
Efficiency of vaccination
In 2000, to the widespread introduction of hib vaccines in countries with limited resources, hib infection was the cause of 8.13 million cases of serious illness in children at the age of 1-59 months (oscillation amplitude - 7.33-13.2 million cases ) and 371,000 cases of death (the amplitude of oscillations - 247 000 = 527,000). By 2008, when 136 WHO member states introduced a hemophilic stick vaccine, it was estimated that 203,000 deaths caused by hib infection occurred, among children under the age of 60 months (oscillation amplitude - 136,000-281,000).
The effectiveness of hib vaccines is 95-100%, the antibody protective titer is preserved at least 4 years.
Among those vaccinated in 10 European countries, Israel and Australia, Hib infection has developed with a frequency of only 2 cases per 1 million; 18% of these children had problems, including prematurity; In 33% there were low levels of immunoglobulins.
Currently, the only means for the prevention of this infection is vaccination. On the recommendations of WHO, the vaccination against hemophilic infection is shown to all children. Vaccination efficiency today is estimated at 95-100%. Numerous tests of polysaccharide conjugated hib vaccines in Europe and North America were carried out. In particular, the clinical trial in the UK (1991-1993) showed a decrease in 87% of the incidence of gemophilic etiology. In Holland, when conducting a similar study, a complete absence of cases of meningitis of hemophilic etiology was recorded within 2 years after the start of immunization.
Modern vaccines are chemically connected antigen of the hemophilic stick capsules and tetanus antecisin, which is needed in order for the main antigen to produce immunity in children under 18 months.
Recommended calendars. WHO recommends any one of the following vaccination calendars against hib infection:
- 3 doses within the primary vaccination course without a booster dose (3p + 0);
- 2 doses within the primary vaccination course and booster dose (2p + 1);
- 3 doses within the primary vaccination course and booster dose (3p + 1).
In countries where the peak of the burden of heavy disease is a hemophilic infection of type B falls on infants of younger age, the introduction of 3 doses of vaccine at an early age can benefit.
By order of the Ministry of Health of the Russian Federation No. 125 dated 21.03.14. Vaccination against hemophilic infection Type B was introduced into the national calendar of the preventive vaccinations of the Russian Federation for children from risk groups.
Read more about Vaccines
The incidence of hib meningitis in Russia is estimated as 16.9 per 100 thousand children 0-5 years, mortality with this disease is 15-20%, 35% develop persistent defects. In Russia, the infection is registered since 2007 (single messages). In Moscow in 2005-2007 Of the deciphered 83 cases of purulent meningitis 47 (57%) were caused by hemophilic infection.
Historical information and interesting facts
For the first time, the hemophilic stick of the influenza was highlighted by Richard Pfeiffer during influenza pandemic in 1889 and mistakenly adopted for the cause of flu, which determined its name (Bacillus Pfeiffer). In 1920, Vincel and colleagues who discovered the need for the growth of microorganism of erythrocyte factors, it was renamed Haemophilus ("Loving Blood"). In 1933, the dependence of the incidence of hemophilic infection from age was discovered by Photogill and Wright.
Hemophilic infection - a group of acute infections caused by bacterium - hemophilic stick (Haemophilus influenzae).
Depending on the type of hemophilic stick, there are several variants of the course of hemophilic infection. The rate of infection varies from light to extremely heavy, life-threatening.
Heavy forms causes bacterium Haemophilus influenza type b. (HIB). Hib infection - purulent meningitis, sepsis. The most dangerous for children under 5 years old.
Also, the hemophilic wand causes otitis, meningitis, arthritis, epiglotte (inflammation of the epiglotter), pneumonia, etc.
The structure of morbidity
Thanks to the vaccine-philatex in the Russian Federation, the incidence of hib infection is registered on a sporadic level.
The causative agent of Hib -Infection is a hemophilic chopstick type b.
The hemophilic stick of type B may be a representative of the normal microflora of the mucous membrane of the upper respiratory tract. The carriers can be from 5 to 80% of the population depending on epidemic conditions.
The level of carriage of the bacteria H. influenzae type B among children is approximately 1 - 10%, in conditions of bought in children's teams - up to 40%.
Man sick of any form of hib - infection or bacteria carrier.
Hemophilic infection is transmitted by air-drip during sneezing, when coughing.
In the risk group
-the with diseases of the nervous system, immunodeficiency states, anatomical defects, leading to a sharply increased risk of hemophilic infection; with intestinal development anomalies; with oncological diseases and / or long-term immunosuppressive therapy;
- Details born from mothers with HIV infection; - Delicate with HIV infection;
-Donal and low-tech children;
- Children in the children's homes.
(Order of the Ministry of Health of Russia of 04/24/2019 N 243N)
Due to the probability of a long asymptomatic flow of hib infection, the incubation period is practically impossible to determine.
Period of infectiousness
The patient with hemophilic infection becomes the most contagious from the appearance of symptoms of the disease and continues to allocate the pathogen about 10 days.
Manifestations of the disease depend on the localization of the pathogen.
If the pathogen does not fall into the bloodstream, the clinical picture of the Orz is developing - nasal congestion, sore pain, conjunctivitis, etc. Finding into the bloodstream, spinal fluid, hemophilic wand causes the development of septicemia, epiglotte, septic arthritis, osteomyelitis, myocarditis, meningitis, etc.
The symptoms of meningitis (about 95% of cases are children from 1 month to 5 years): a sudden beginning, fever, headache, light-free, rigidity of the occipital muscles (in small children may not be), nausea, vomiting.
Symptoms of pneumonia: fever, chills, headache, weakness, abundant sweating, cough, difficulty breathing, chest pain,
Symptoms of septicemia: confusion of consciousness, fever, nausea, diarrhea, abdominal pain. Danger of lightning flow with fatal outcome.
Than dangerous disease
U10-15% underwent hib infection develop severe complications (epilepsy, deafness, cerebral paralysis). 15-20% are likely such complications as partial deafness, behavioral difficulties and difficulties in learning, as well as problems with speech and language. Complications are long-term.
The diagnosis is established on the basis of a clinical picture and laboratory data.
Patients with suspected meningitis are treated in an infectious hospital.
Vaccinoprophylaxis makes it possible to avoid more than 90% of cases of hib infection infection, but the hib infection vaccine does not prevent the disease caused by other types of hemophilic sticks.
Children vaccination diagram
Vaccination against hemophilic infection is provided for children from risk groups. The first vaccination is carried out at the age of 3 months. , Second in 4.5 months. Third - at 6 months.
Revaccination: 18 months.
Contraindications for vaccination
-the sensitivity to vaccine components, including tetanus,
- Allergic reaction or post-specific complications for previous doses of HIB-vaccines.
Reaction to the introduction of the vaccine
In rare cases, local responses are noted with a possible increase in temperature, which is ongoing no more than two days: soreness at the injection site of vaccine, swelling, temperature increase, decreased appetite.
Non-specific prophylaxis is in compliance with the rules of personal hygiene and conducting a healthy lifestyle.
Hemophilic infection - acute anthroponous infectious disease with an aerosol mechanism for transmitting the pathogen, which is characterized by the preferably damage to the respiratory tract and brain shells.
Codes on the ICD -10 A41.3. Septicemia caused by Haemophilus Influenzae (Afanasyev-Pfeiffer wand). A49.3. Infection caused by Haemophilus Influenzae, unspecified. B96.3. Haemophilus influenzae as a cause of the disease classified in other categories. J14. Pneumonia caused by Haemophilus Influenzae.
Etiology (reasons) hemophilic infection
The pathogen is the bacterium Haemophilus Influenzae (H. Influenzae, Sin. - Pfeiffer wand). Hemophilic wand of the genus Haemophilus (PasteureLaceae family) is a small kokokobacillina, may have a polysaccharide capsule. In the environment unstable. It has k- and o-antigens. Six servers (A, B, C, D, E, F) are distinguished along the capsule antigen. From the representatives of Hemophilus for a person's pathogenic only H. influenzae type B (HIB). The main factors of pathogenicity - capsule and drank. The capsule suppresses the phagocytic activity of leukocytes, the saws provide adhesion of the pathogen to the cells of the epithelium. Additional pathogenicity factors - IGA proteases, splitting secretory immunoglobulins.
Photo of hemophilic sticks in an electronic microscope after painting by gram
The causative agent also contains a lipopolysaccharide and glycoprotein complex. There are data on the essential role of LPS in the pathogenesis of ITS in patients with HIB infection. H. influenzae is a small resistant in the environment. Pervents for 30 minutes at a temperature of 55 ° C, under the influence of sunlight and drying. Disinfecting solutions in commonly used in practice concentrations kill N. Influenzae in a few minutes.
Epidemiology of hemophilic infection
Source infection - Patients with any clinical form of HIB infection, as well as healthy carriers. The frequency of nasopharyngeal hemophile carriages can reach 90%, but the HIB capsule strains, with which almost all cases of the disease are associated, detect only in 3-5% of the surveys.
The main path of transmission of the pathogen - airborne drip; Possible contact path. The susceptibility of man has been studied bad. It is known that the probability of infection in children from 3 months to 5 years is 6,000 times higher than in other age groups. Apparently, the high susceptibility of children under 5 years of age (more than 90% of patients) is due not only to the absence of immunity, but also anatomy-physiological characteristics.
Pathogenesis of hemophilic infection
Entrance gate infection - The mucous membrane of the upper respiratory tract, where the causative agent can persistently persist for a long time. With this localization of the pathogen are associated with ARS caused by HIB, epiglotte, otitis, sinusitis. The mechanism of developing hemophilic pneumonia is unknown. With violation or inferiority of protection mechanisms, the causative agent overcomes the barrier of the mucous membrane and falls into the blood. Bacteremia leads to the development of septicemia (ITSH), arthritis, osteomyelitis and meningitis can be complicated as a result of the penetration agent through the BGB. At the same time, the protective resources of the body are limited to phagocytosis, which explains high mortality (over 50%) in the absence of adequate therapy. Hemophilic meningitis (Hib-meningitis) is the most typical and frequent form of HIB infection. In the development of the disease, three phases are detected:
· Phase respiratory infection; · Bacteriamia (gemoculture frequency over 60%); · Phase meningitis.
Clinical picture (symptoms) hemophilic infection
The Hib infection incubation period is, apparently, from two to four days. There is no single classification of HIB infection. It is advisable to allocate asymptomatic carriage, localized [ARZ (rinopharyngitis), ORZ, complicated by sinusitis, otitis; phlegmon, cellulite] and generalized (invasive) forms of the disease (epiglotte, PNVMONI, septicemia, meningitis, osteomyelitis, arthritis).
ARZ, caught by Haemophilus Influenzae, do not significantly differ from ORZ other etiology, but often complicated by otitis and sinusitis.
Epiglottitis - Inflammation of the epiglotter, the heavy form of Hib infection. More often observed in children 2-7 years. Start sharp: chills, high fever, salivament. For several hours, the symptoms of DN (inspiratory shortness of breath, tachycardia, stridor, cyanosis, taching of militant sections of the chest) increase). Patients occupy a forced position. It is possible to develop septicemia, meningitis.
Phlegmon. Observed in children up to 1 year, the most frequent localization is head and neck. The clinical picture can remind meal. Bactemey and meningitis are possible.
Cellulite Also observe children under 1 year; More often is localized on the face and neck. Often develops against the background of rinoporgitis. In the area of the cheek or around the orphanage, hyperemia with a blue tint appears on the neck and skin soloity. General intoxication is not expressed, but can join otitis, meningitis and pneumonia.
Pneumonia. The clinical picture does not differ from that with pneumococcal pneumonia. It may be complicated by meningitis, pleurite, septicemia.
Septicemia. More often observed in children up to 1 year. It is characterized by hyperthermia, often with hemorrhagic rash, the development of ITSH.
Osteomyelitis, Arthritis Usually develop against the background of septicemia.
Meningitis caused by the hemophilic stick type B (Hib-meningitis), occupies a 3rd place in the frequency of occurrence in the etiological structure of bacterial meningitis, ranging from 5 to 25%, and in children under 5 years old - 2nd place (10-50 %).
Having a lot of common features with other types of bacterial meningitis, Hib-meningitis is characterized by a number of essential clinical and pathogenetic features that need to be considered in the early diagnosis and choosing the optimal tactics of etiotropic and pathogenetic therapy. Hib-meningitis amazes predominantly children under the age of 5 (85-90%). Often (10-30%) are sick and children up to 1 year, including the first month of life. The share of children over 5 years and adults accounts for 5-10% of the fallen. In most patients with HIB meningitis develops on a burdened premorbid background (organic lesions of the central nervous system, burdened for the second half of pregnancy and childbirth, frequent respiratory infections in history, violations in the immune system). In children over 5 years and adults, anatomical defects are essential (Spina Bifida). These patients, as a rule, are repeatedly sick with bacterial meningitis of various etiology.
The disease becomes more likely: From cough, runny nose, increase body temperature up to 38-39 ° C. In some patients, dyspeptic disorders can dominate in the initial period. This period lasts from several hours to 2-4 days, then the state of the child deteriorates: the symptoms of intoxication increase, the temperature reaches 39-41 ° C, the headache is enhanced, vomiting, meningeal symptoms, consciousness disorders, convulsions are joined, and after 1-2 days - Focal symptoms. In the acute beginning of the disease, catarrhals may be absent. Disease in these cases begins with a quick increase in body temperature up to 39-40 ° C, headaches, vomiting. Disconnected meningeal syndromes appear on the 1st day of the disease. On average, the clear signs of the TSS defeat with Hib-meningitis are celebrated 2 days later than with meningococcal meningitis, and a day later than with pneumococcal meningitis. This often leads to late diagnosis and late start of etiotropic therapy.
Fever with Hib-meningitis more often remitting or incorrect, is recorded even against the background of antibacterial therapy, duration from 3-5 to 20 (an average of 10-14) days and more. The level of fever is higher than in the bacterial meningitis of other etiologies. Rash is possible in some cases. Catarial phenomena in the form of pharyngitis detect more than 80% of patients, rhinitis - more than 50% of patients. Less often noted the phenomena of bronchitis, in individual patients - pneumonia. Often enlarged spleen and liver; There is no appetite, vomiting occurs, flashing food, latency of the chair (but diarrhea is possible). The ability of consciousness, adamina, fast depletion is characteristic of most patients. It is less likely to develop a copor, in some cases - coma.
Against the background of dehydration and adequate antibacterial therapy, consciousness is completely restored in time from 4-6 hours to 2-3 days. A pronounced picture of the brain edema is observed about 25% of patients, but signs of brain dislocation (coma, generalized convulsions, respiratory disorders) are significantly less common.
At the same time, focal neurological symptoms detect at least 50% of patients. More often noted by the paresis of cranial nerves, worsening hearing, focal cramps, ataxia, impaired muscle tone for extrapyramidal type, less frequently paresis limbs.
Meningkeal syndrome (in particular, blowing the spring), the symptom of hanging is expressed moderately. Muscle rigidity The nape is usually characteristic of children over 1 year old, and the symptoms of the Brudzinsky and Kerniga in part of the patients are weakly expressed or missing. The picture of the liquor is characterized by moderate neutrophil or mixed pleyocytosis, a small increase in the level of protein. The turbidity of the liquor can be due to a huge amount of hemophilic stick, which in microscopy takes all the field of view. The content of glucose in the first 1-2 days varies from a sharp decline before raising the level, after the 3rd day - less than 1 mmol / l or glucose is not determined.
The picture of the blood is characterized by weakly or moderately pronounced leukocytosis: almost half of the patients with leukocytosis, in the remaining normocytosis or leukopenia. In the majority of patients - absolute lymphopenia (up to 300-500 cells in 1 μl), as well as a tendency to reduce the number of erythrocytes and hemoglobin.
Diagnosis of hemophilic infection
The clinical diagnosis of any forms of Hib infection, except for epiglotte, indicative, as Hib is the most frequent pathogen. The diagnosis of HIB infections is determined on the basis of the release of gemoculture of the pathogen and culture from pathological secrets (SMG, PUB, pleural effusion, sputum, nasopharynk strokes). In the latter case, the diagnostic value is only the release of capsule strains. For sowing use chocolate agar with growth factors. For the diagnosis of meningitis, bacterioscopy, PCR and the reaction of the RLA of the SMG are also used.
Differential diagnosis of hemophilic infection
Epiglotte is differentiated from the diphtheria of the upper respiratory tract, cereals with ORVI and the foreign body in the larynx (Table 17-38). Other forms of Hib infection are distinguished on the basis of the results of laboratory studies. Hib-meningitis is differentiated from other types of bacterial, viral meningitis, meningism during acute feverish diseases.
Table 17-38. Differential diagnosis of acute epiglotte
|Symptoms||Nonological form||Non-thorn body in the larynx|
|Acute epiglotte||diphtheria||cruise at ARVI|
|Fever||High||Subfebrian||Subfebrile, up to 38-39 ° C||Is absent|
|Intoxication||Sharply expressed||Not characteristic||Not expressed||Is absent|
|Aphonia||Hoarseness voice||Aphonia||Hoarseness voice||Hoarseness voice|
|Catarial phenomena||Weakly expressed||Absent||Characteristic||Absent|
|Saving||Characteristic||Is absent||Is absent||Not characteristic|
|Difficulty when swallowing||Characteristic||Is absent||Is absent||Is absent|
|Pain in swallowing||Characteristic||Absent||Possible||Possible|
|The degree of stenosis of Gortani.||III-IV.||III-IV.||I-II.||I-II.|
|Laryngoscopy.||Sharp edema and hyperemia of the Nastestrian, the edema of soft tissues||Voice bundles||Hyperemia, swelling space||Foreign body in the lumen or wall of the larynx|
Indications for consultation of other specialists
In signs of lesion, the CNS shows the consultation of the neurologist, with local purulent-inflammatory foci - surgeon; In the signs of the stenosis of the larynx - otolaryngologist.
Indications for hospitalization
Clinical: the presence of meningkeal syndrome, day, stenosis of larynx, local purulent-inflammatory processes (phlegmon, cellulite, arthritis, osteomyelitis). The regime in the hospital is bed.
An example of the formulation of diagnosis
A41.3. Septicemia caused by HIB, purulent meningitis, ongm.
Treatment of hemophilic infection
The duration of treatment is at least 7-10 days.
Table number 13. With epigetytte - table No. 1a, parenteral or probe food.
Ethiotropic therapy of generalized disease forms is presented in Table. 17-39.
Table 17-39. Etiotropic therapy of generalized HIB infection forms
|A drug||Daily dose, mg / kg||Multiplicity of introduction||Path of administration|
|Preparations of the first row|
|Chloramphenic||25-50, with meningitis - 80-100||3-4||Intravenously, intramuscularly|
|Amoxicillin-Clawulanic Acid||thirty||3-4||Osually, intravenous|
|Cefotaxim||50-100, with meningitis - 200||4||Intravenously, intramuscularly|
|Ceftriaxon||20-80, with meningitis - 100||1-2||Intravenously, intramuscularly|
|Second row preparations|
|Meropem||30, with meningitis - 120||3||Intravenously|
|Ciprofloxacin||20, with meningitis - 30||2||Osually, intravenous|
For the treatment of localized forms, it is also used: · azithromycin at a dose of 10 mg / kg orally one-time; · Roxitromycin - 5-8 mg / kg twice a day orally; · Co-trimoxazole - 120 mg twice a day orally for 3 days.
Pathogenetic therapy is prescribed, based on clinical indications, and are carried out according to general rules. Under meningitis, dehydration therapy (furosemid, acetazolamide in medium therapeutic doses are shown; dexamethasone at a dose of 0.5 g / kg per day intravenously or intramuscularly).
During ONGM, use IVL, oxygen therapy, anticonvulsants.
In acute epiglotte, tracheal intubation, loop diuretics, glucocorticoids, antihistamines are shown.
With local pumping processes (phlegmon, osteomyelitis) use surgical treatment methods.
Forecast hemophilic infection
Under meningitis, septicemia, epiglotte - serious, with other Hib infection forms - favorable. After meningitis, resistant hearing loss, hydrocephaly-hypertensive syndrome are possible.
Terms of disability under meningitis are 1-2 months after discharge from the hospital.
With Hib meningitis shown. Carries neurologist, duration of at least 1 year.
Prevention of hemophilic infection
Specific prophylaxis are carried out according to individual indications (frequent ARVI, the pathology of pregnancy and childbirth from the mother, the defeat of the CNS of the child). Vaccines are used:
· Act-Hib (France) at a dose of 0.5 ml intramuscularly or subcutaneously (from 2-3 to 6 months - three times with an interval of 1-2 months with one-time revaccination after 1 year; from 6 to 12 months - twice with intervals 1 month and revaccination after 18 months; from 1 year to 5 years - once);
· Hiberix (Belgium) at a dose of 0.5 ml subcutaneously or intramuscularly (from 3 weeks to 6 months - three times with intervals of 1-2 months and revaccination after 1 year; from 6 months to 1 year - twice with intervals 1 month and one-time revaccination After 18 months; from 1 year to 5 years - once).
Not so long ago, a new term "hemophilic infection" appeared on a hemophilic infection and calling his children against her. That's just what kind of infection, and what it is dangerous, know a few. In this article, MedABoutMees knows you with the causative agent of hemophilic infection in children and tell about the main clinical forms of the disease.
A little about the pathogel - hemophilic stick
Haemophilus Influenza is a hemophilic infection causative agent. Otherwise, it is called hemophilic chopper or a punthefer wand. It refers to gram-negative microbes, occurs in the form of chopsticks or cocked (rounded) cells. The microbes themselves are still, do not have the ability to form disputes. But they have a property to acquire capsular shapes, which causes some of their pathogenic properties.
Several serological types of hemophilic sticks are isolated. The most often pathological processes in humans cause a hemophilic chopstick type B (hib infection). It is this serotype that becomes a culprit of severe manifestations of diseases that can end with death.
By itself, this microorganism is considered a conditional pathogenic, that is, can live in a person's body and do not harm. But among young children, it can cause outbreaks of the disease. This occurs as a result of the appearance of the clones of the pathogenic microbe, which has properties cause pathological processes in the human body.
Sometimes outbreaks of disease are found in maternity hospitals, in hospitals with chronic patients, in patients receiving hormones and cytostatics in therapy.
The source of the spread of the pfefer stick is becoming sick with hemophilic infection, as well as externally healthy carriers. The airborne path is the main in the transmission of infection. The causative agent can get into the human body through clothes, towels, books, toys, household items.
Features of hemophilic infection in children
Children are infected with hemophilic infection from other children, parents, medical personnel. Particularly susceptible to the causative agent, children suffering from immunodeficiencies, especially those born ahead of time.
The most significant factors of the disease are:
- Early age;
- Reducing local protection against infections;
- A general reduction in body resistance to infections.
In addition, the role of a genetic predisposition to the disease is played, a combination of different infections in the kid at the same time, as well as the emergence of epidemic clones of H. influenza.
Usually, the hemophilic stick in healthy children (carriers) settle on the mucous membranes of the respiratory tract. It is very often a hib infection with them becomes a complication of another infection caused by viruses or bacteria.
When infected with a puntefer wand outside the child develops a disease in the form of angina, ear inflammation, inflammation of bronchi or pneumonia. In more severe cases, meningitis, sepsis, phlegmon and abscesses are sometimes developing.
It is necessary to note the fact that antibodies against hib infection play a significant role in the formation of immunity against other infections too. The formation of antibodies in a child occurs either after infection with a hemophilic stick, or after vaccination against it.
It is almost impossible to protect the child from infection with a hemophilic stick. He still meets with her by visiting public places, transportation and educational institutions. The only question is whether the causative agent will cause a child's disease, and in what form it will leak.
Pneumonia with hemophilic infection
Among all children, patients with pneumonia (inflammation of the lungs), in 5% of cases, the disease is caused by the hemophilic wand. Among the patients with pleuritis (inflammation of the pleura), Haemophilus Influenza is seized even more often. Children's disease are especially susceptible to two years old.
For hemophilic pneumonia, a sharp beginning is characteristic, an increase in body temperature to high values, strong intoxication. In general, the clinical picture is difficult to distinguish between other pneumonia caused by bacteria.
The pathological focus is most often located near the roots of the lungs, but it also happens in other departments. Pneumonia happens to one or on both sides. Sometimes a plot of inflammation in the lungs is absced. The pneumonia is confirmed by a radiological study of the lungs.
A general blood test usually does not reflect serious inflammatory changes in the body, as expected with such a pathological process. This serves as a peculiar marker in favor of the hemophilic pneumonia.
Inflammation of cerebral shells with hemophilic infection
Purulent inflammation of the brain shells (purulent meningitis) in kids to three years of age is usually due to the defeat of the child's body with hemophilic infection type B. The kids often suffer in the first months of life.
Symptoms of the disease are not distinguishable from meningitis of other bacterial origin. Draws attention to the sharp beginning, pronounced intoxication, multiple vomiting, neurological symptoms, may be a violation of consciousness.
Pathological studies of the cerebrospinal fluid correspond to those with other bacterial meningitis. It is possible to suspect hemophilic meningitis that if the inflammation of the brain shells is combined with the presence of pathological foci in other organs (osteomyelitis, pneumonia, sinusitis, sepsis, etc.).
Unfortunately, hemophilic meningitis sometimes becomes the cause of the child's death. And the surviving babies often remain persistent neurological disorders (paralysis, convulsive syndrome, violation of psychomotor development, speech, hearing, etc.).
Inflammation of the epiglotter in hemophilic infection
This form of hib infection disease belongs to one of the most heavier. The other name is sharp epiglotte. Children are more likely from 2 to 5 years. The disease begins acutely with the appearance of symptoms of intoxication, sore throat, problems with swallowing, shortness of breath. Respiratory problems are due to the fact that the inflamed one is hosted (located at the root of the tongue) overlaps the respiratory tract.
There may be such symptoms as a very sipid voice, saliva, throwing the head back. When examining the pharynx, the edema of the cherry color is noticeable, if you press the root of the language.
If you can not help your child in a timely manner, then it can be lost. In emergency cases, the intubation tube or tracheostomy is introduced into the respiratory trachestomy.
Other common clinical forms of hib infection in children
- Pannaculitis - inflammation localized in fatty tissue (cellulite). Chicks are more painful in the first year of life. It is manifested in that on the head of the child (the hairpiece), in the area of the face and neck, painful dense sections of the subcutaneous fiber of a bluette shade up to 10 and more see can be accompanied by inflammation in other organs (medium otitis, pneumonia, etc.).
- Pericarditis - inflammation of the shallower bag. 15% of all cases of pericarditis in kids are caused by hib infection. In addition to intoxication, the child has a rapid heartbeat, deaf heart tones, respiratory problems. This form of infection is also very heavy, can lead to the death of a child.
- Purulent arthritis is inflammation of the tissues of the joints. Sometimes the cause of arthritis in children is exactly the hemophilic wand. Characteristically involved in the process of large joints. Hemophilic arthritis proceeds, like any other bacterial arthritis.
- Osteomyelitis is an infectious process affecting the bone tissue, periosteum and bone marrow. Inflammation of bone tissue with hib infection is the same as with other infections caused by bacteria. The long tubular bones of the limbs suffer.
- Acute Middle Otitis - Inflammation of the middle ear. It takes ways as well as Otitis with other infections. It is worth noting that 20-30% of all Otitis occurs due to the infection of the child with a hemophilic stick.
The infection caused by H. influenza is treated with antibiotics: third-generation cephalosporins, macrolides, less often antibiotics of penicillin row, leftomycetin and aminoglycosides. In addition to antibacterial drugs, the child is appointed by a lining and symptomatic treatment.
Currently, you can make a child vaccination against hemophilic infection type B, starting from three months. Vaccination is carried out according to the calendar of preventive vaccinations in children.
Hemophilic infection - This is a group of bacterial infections caused by the influenza stick (Pfeiffer). The most often affected by respiratory organs, brain, musculoskeletal system; During generalization, sepsis occurs. About a third of those perverse remain lifelong disabled people or have persistent disorders of the CNS, joints, ENT organs. The diagnosis of hemophilic infection is based on the detection of the causative agent (molecular genetic, bacteriological study), the growing titer of antibodies to the pathogen (IFA). Treatment: etiotropic antibiotic therapy, pathogenetic measures, symptomatic therapy.
Hemophilic infection (hib infection) is a pathological process caused by conditionally pathogenic microorganisms. The causative agent was opened in 1892 by the German immunologist R. Pfeiffer (the wand is surname). Infection is common everywhere, the incidence rises in the winter-spring period. Up to a third of all meningitis of children's age is caused by a hemophilic wand. Preferably children suffer from under 5 years old, there are no gender differences. According to some data, up to 40-70% of children attending preschool institutions are carriers of bacteria.
The causative agent of infection - the bacterium of the genus Haemophilus (view of N. influenzae), most often the defeat in humans calls H. influenzae type b. The microorganism is a conditionally pathogenic representative of the normal microflora of the mucous membranes of the person's respiratory tract. A source of infection can be healthy carriers, as well as sick people. The transmission paths are air-drip, children are often combined with contact (through common toys, cutlery).
The high-risk group is accommodating in homes of the elderly, boarding schools, faces after splenectomy, newborn children on artificial feeding, HIV-infected, patients, long-term systemic glucocorticosteroids, oncological patients. The main risk factors:
- Age: up to 2 years and older than 60;
- Harmful dependencies: alcoholism, drug addiction;
- heart defects;
- unsatisfactory sanitary and hygienic conditions.
The pathogenesis of infection is finally understood. If the human body gets inside the body, bacterium persists in the entrance gate, being out and intracellularly. Colonization can occur typically and unwashed strains with a dynamic shift of the microbial landscape. The serotype B has proteases that can inactivate the secretory immunoglobulins of the mucous membrane. The hemophilic stick capsule proteins can block phagocytosis.
With a decrease in the resistant properties of the organism (concomitant viral lesion, stress, supercooling) arises activation of the reproduction of the pathogen and local inflammation. The hemophilic stick can pentimerize the mucous membrane, fall into systemic blood flow, spread through target organs (brain, light, soft tissue). Bacterium is able to multiply in the blood, forming bacteremia with secondary foci, and then a septic state.
Hemophilic infection is more often a disease associated with the transition of latent pathology into the manifest after the asymptomatic colonization of the upper respiratory tract by microorganisms. Hib infection can be classified by clinical manifestations:
- Invasive. Includes epiglotte, meningitis, pneumonia, bone damage, joints, subcutaneous fatty fiber. More than 85% of cases is detected in children under 4 years old.
- Non-invasive. It is often caused by unwashed strains, proceeds as a recurrent sinusitis, otitis, conjunctivitis. Amazed both children and adults.
- Sepsis. Characteristically stormy, high mortality, lack of secondary foci. Usually ill babies at the age of 6-12 months, girlfriends. Patients die from septic shock.
Symptoms of hemophilic infection
Hib infection has a short incubation period - 2-4 days. The symptoms differ depending on the damaged organ, but in typical cases begin to sharpen with an increase in body temperature of more than 38.5 ° C, chills, weaknesses. When inflammation of the epiglotter suffers, the ability to speech, swallowing, sinking occurs, the lack of air on the breath. Breathing becomes noisy, the skin becomes a shiny shade. Patients sit, stretching his chin and fed forward.
For the start of meningitis, the manifestations are characterized by ARVI: cough, runny nose, fever more than 38 ° C. Then there are inhibition, pronounced headaches with vomiting at the height of the pain peak, the rigidity of the occipital muscles, the lights. There are nonsense, hallucinations, drowsiness. The addition of sepsis manifests hemorrhagic rash on different parts of the body. On the face, the neck occurs painful red seals (cellulite, phlegmon).
Symptoms of pneumonia - runny nose, dry cough, throat. A few days later, the increase in cough jesters, the appearance of poor sputum, chest pain during inhalation, fever more than 39 ° C. Patients note the increasing lack of air, pallor, and then skin sinusiness, abundant sweating. Dyspnea at first noticeable only during exercise, over time appears alone. Weakness increases, a forced position is required.
In children, before the first year of life, the symptoms of meningitis caused by the hemophilic stick can manifest itself as a resistant fever over 39 ° C, not bought by antipyretic means, joining (equivalent of vomiting), a constant piercing "brain cry". Often, convulsions arise, twitching the mimic muscles, escape and the ripple of a large spring. Children may refuse food, becoming sluggish, single or, on the contrary, to remain in psychomotor excitation.
Hemophilic infection has a number of complications, the main of which is acute respiratory failure. It develops as a result of asphyxia or due to swelling of respiratory fabric. Up to 70% of cases of pneumonium caused by hemophilic bacterium, children are complicated by pleurite. Often there are abscesses of the nastestrian. Hazardous complication of meningitis is the swelling of the brain.
Sepsis causes symptoms of polyorgan deficiency in 20% of patients. The long-term consequences of transferred hemophilic infection: chronic pathologies of ENT organs (otitis, sinusitis, deafness), blindness after meningitis and endophthalmite, osteomyelitis. Up to 50% of children who suffered with hemophilic meningitis are obtained by a disability group. Rare complications are chronic pericarditis, arthritis.
The diagnosis of hemophilic infection is carried out by doctors of various specialties, more often by pediatricians, infectious examines. It is important to carefully collect epidemiological history, especially the vaccination history of a child or an adult. The main laboratory and instrumental and clinical signs of the disease:
- Physical data. Objectively detects the symptoms of the bottoms: shortness of breath, change of skin shade, accomplishing intercostal intervals, forced position. Hemorrhagic rash is determined on the skin of the body and limbs during sepsis. Neurological manifestations include muscle rigidity, a positive symptom of Lasga, Kerniga, Brudzinsky. Purulent lesions of the skin look hyperemen, fluttering, eaters, sharply painful.
- Laryngoscopy. Symptoms of epiglotte require an inspection of the ENT doctor with a visual assessment of the condition of the respiratory tract. With indirect laryngoscopy, zea hyperemia is revealed, a large amount of saliva, mucus. The nastestrian is increased in sizes, a crimson-blue shade, the entrance to the lads is narrowed from behind the edema of the walls.
- Laboratory research. The leukocytosis is determined with a sharp shift of the formula to the left, the acceleration of ESO. In sepsis, anemia arises, thrombocytopenia, the growth of liver transaminase activity, urea, creatinine, as well as bilirubin, d-dimer, hypoalbuminemia is registered. In OAM - an increase in density, proteinuria, red blood cell. Likvorogram is characterized by neutrophil pleaocytosis .
- Identification of infectious agents. The detection of the bacterium is produced by microscopy and sowing to the nutrient medium of wasches from the nasopharynx, zea, sputum, liquor, blood, or purulent discharge. The fastest method of detection of the infectious stick is PCR. Serological diagnostics (IFA) is carried out in paired serums with an interval of at least 14 days, serves to retrospective confirmation of the diagnosis.
- Tool method s. It is necessary to conduct an x-ray of the organs of the chest or low-dose CT lungs. The x-ray of the neck in the side projection is used in suspected epiglotte. In severe cases, the optical fiber laryngrechoscopy is possible. Recommended ultrasound of soft tissues, abdominal cavity. With the symptoms of meningitis, lumbar puncture is required.
Differential diagnosis is carried out with purulent meningitis and pneumonia of other etiology (often differences only laboratory, are determined when the pathogen is selected). Epiglotte is clinically similar to paratrozillary, cap abscesses. A similar clinic has mining bodies of larynx, burns with acids, alkalis, but in these cases, the details of the history are usually known. It may be necessary to exclude acute stenosis laryngitis, true diphtheria.
Treatment of hemophilic infection
Indications for hospitalization
Hib infection in the form of epiglotte, phlegmons, lesions of fatty fiber on face or meningitis - an indication for emergency hospitalization, often in the separation of intensive therapy. Stationary treatment is recommended, based on the severity of the state. So, pneumonia without respiratory failure can be stopped outpatient. There are epidemic testimony for the hospital passage of therapy.
Until 5-7 days of the normal body temperature during meningitis and inflammation of the native, a strict bed mode is assigned, the prevention of layers, hypostatic pneumonia is carried out. A high-protein, vitaminized diet, an increase in water load (in the absence of contraindications) is recommended.
Patients with hemophilic infection must necessarily receive antibacterial agents that need to be entered from the first hours of confirmation of the diagnosis. Treatment is better to start with infusion drug administration. It is important to carry out a self-sanation, since 70% of patients who caregoing are detected by pathogenic hemophilic sticks. Therapeutic tactic includes:
- Etiotropic treatment . Antibiotics of a wide range of action are prescribed, taking into account growing antibiotic resistance. Selection preparations: protected penicillins, cephalosporins, you can use macrolides, carbapenes and fluoroquinolones.
- Pathogenetic means . A massive infusion disintellation is carried out by hydroxyethyl strokes, crystalloids, the introduction of albumin solutions, freshly frozen plasma. It is possible to appoint NSAIDs, less often glucocorticosteroids.
- Symptomatic therapy . Includes antipyretic, painkillers, sedatives and other drugs - Mukolitiki, antitussive. Diuretics, hydrochiotherapy, anticonvulsants are used. Correction of acid-alkaline balance, compensating chronic pathologies.
It is carried out in the event of phlegmon and abscesses, especially on the face. In half of patients with purulent arthritis, shoulder and hip joints arises the need for medical arthroscopy. Local treatment after a wide excision of the purulent focus is washing, using antiseptics for dressings in soluble, less frequently, ointment forms. Often, tracheostomy is carried out to improve the passability of the respiratory tract.
Prediction and prevention
The forecast is always serious and depends on the form of hemophilic infection. Mortality reaches 10-20%. Specific prophylaxis has been developed. Vaccines are allowed to be administered from 3 months of life, according to the scheme 3-4.5-6 months, revaccination is carried out at 1.5 years. Applied both in the form of multicomponent (pentaxim, infanrix hex) and monopreparatics (Akthib, Hiberix). After 5 years, vaccination is not conducted healthy children.
Non-specific measures are sanitary and educational work with the population, the sanation of bacteria carriers in the foci, improving the living conditions. An important link of prevention is the isolation of patients and contact persons at home or hospital, quarantine events in children's institutions (up to 10 days). Emergency antibioticoprophylaxis is shown to persons from risk groups.
More than a century ago, doctors believed that the influenza develops the hemophilic stick (Pfeiffer sticks) in the human body. However, today it is known that hemophilic infection is something else. Modern medicine claims that hemophilic infection causes the occurrence of diseases of the brain, joints and lungs in the human body. The worst thing is that hemophilic infection is especially dangerous to small children under the age of 1-5. To prevent the occurrence of severe diseases caused by the pofaffer stick, specialists are offered today to conduct vaccination against hemophilic infection in small children.
Diseases caused by hemophilic chopstick
In the genus "Hemophiluses" there are more than 16 varieties of bacteria, each of which is capable of causing a certain kind of disease. The most dangerous is the hemophilic stick B-type, which causes the most severe changes in the human body, and the congestion of which is a modern vaccine.
Under hemophilic infection, doctors understand a number of hard pathologies, which are caused by one causative agent - hemophilic wand. The hemophilic wand may be on the mucous membranes of 100% of healthy people, it is its natural habitat in wildlife. Anyone can serve as an asymptomatic bacteria carrier that does not fall ill, but spreads infection. The main risk group for such infections, which often end with complications, is the age group of children from six months to 4-5 years. This is due to the weak protective functions of small children, compared with adults, a huge load on the children's body at an early age due to active bacterial reproduction for the formation of natural flora and adaptation to the world around the world, with frequent meetings of a small child with another unknown organism by causative agents.
Such conditions lead the organism of the rapid child to the loads, in the light of which contact with the causative agent of hemophilic infection often develops into severe diseases. In order to avoid such difficulties, it is necessary to vaccinate a newborn, which will help protect the body from various complications characteristic of hemophilic infection.
Among the main diseases that arise due to provocation in the body of a child of hemophilic infection, doctors identify the following severe pathologies:
- inflammatory processes in the shells of the head or spinal cord (purulent meningitis);
- inflammatory processes in human lungs (pneumonia, pleurisy);
- purulent inflammatory process in the middle ear (otitis);
- purulent arthritis and other severe joint pathology;
- blood infection (septicemia);
- purulent diseases localized in the upper respiratory tracts and in the internal organs (in the heart, hymic commodity sinuses and other);
- Inflammatory processes in the field of subcutaneous fiber (cellulite).
Most often, the result of hemophilic infection is otitis, pneumonia or meningitis. These diseases are most often found in children from 6 months to 5 years, and with their discovery, doctors talk about disappointing statistics - more than 5% of all sick at that age dies. However, this fact can be easily corrected, only in a timely manner using the vaccination against hemophilic infection for your child.
The effectiveness of vaccinations against hemophilic infection was proven by scientists in the forties of the last year, but it included in America and the European Union countries only in the 90s of the 20th century. In our country, vaccination against hemophilic infection has become adopted only since 2011. The schedule of its holding completely coincides with the schedules of the remaining age-related vaccinations.
Indications and Vaccination Schedule
Among the main indications for vaccination against hemophilic sticks, the following criteria are distinguished:
- age from 3 months;
- the beginning of visiting preschool institutions;
- the presence in the body of any immunodeficiency (HIV infection, oncological diseases), as well as the postoperative period when removing the spleen;
- elderly age;
- Accommodation in the conditions of a large team of children - a children's house, a large family.
In the first year of life, it is necessary to undergo vaccination against hemophilic infection with absolutely all children. Adults such a vaccine can be administered as desired if there are factors that contribute to the development of hemophilic infection in an adult organism.
Based on that age, when a person is vaccinated, a vaccination schedule against the pofaffer stick is also built. In preparations for vaccinations, a capsule polysaccharide of the hemophilic bacterium shell is used, which is enhanced by tetanus anatoxin. Such a lyophilisate (that is, the substance that all of the above contains in itself) is a white or white dry dry matter that requires dissolution in a liquid medium. Vaccine is introduced subcutaneously or intramuscularly.
The first vaccination of doctors is recommended to be carried out in three months of age, repeated 4.5, and the third in 6 months. Such three-time vaccination protects the faster human body in 95% of cases. After the last vaccination at the age of 18 months (revaccination), the protection of the body from hemophilic stick grows up to 100%.
If, in 3 months, the child was not attracted, then the diagram of the introduction of the vaccine is somewhat modified. So, the first vaccination must necessarily happen at the age of 6 months, and the second is exactly 30 days after the first. Revaccination will need to produce in this case 12 months after the second vaccination.
If the child did not stick to the hemophilic infection, then its vaccination occurs in one stage. As a rule, before this age, the kids are already faced with hemophilic infection and their body independently produces antibodies to the disease, so in this case medicine just tries to help. With a single introduction of the vaccine, the active immune protection of the human body is produced, and when a collision with such an infection, the disease will be easily accurate and without serious complications.
An adult person must first make a test for the presence of antibodies to hemophilic infection, and only then set the chart and the number of necessary applications of the drug.
Side Effects and Reactions to Vaccination
All analogues of vaccine against hemophilic infection have approximately the same characteristics, so in this case it is not too important, which kind of vaccine to the child will be introduced. Reactions to it, as a rule, no either they are very weak. Antibodies against hemophilic sticks, with proper and complete immunization, are produced by the next 4 years of human life and protect it in the most sharp points of collision with infection.
Rarely after vaccination of the child against this disease, you can detect infiltrate, redness in the injection places. Such reactions in most cases speak not about the reaction of the body on the vaccine, but on the introduction of infection during the injection process. Also, after the injection, the body temperature of the child can be slightly increased, it can experience weakness, lethargy, sleep failures and loss of appetite.
After vaccination against hemophilic infection, only one type of side effects may occur - this is a small rash, as with urticaria (urctaria), localized at the injection site (less often - extending throughout the body of a child). This is an allergic response to the drug.
However, all of the above reactions and side effects relate only to one-component vaccines. With the introduction of a multicomponent drug, simultaneously protecting a person from a cough, diphtheria, tetanus, hepatitis B, poliomyelitis, reactions can be more pronounced and strong. This is due to the reactive ability of the human body to respond to the introduction of components aimed at developing immunity. The most common convulsions, high temperature, swelling of legs, pain in injection places, neuritis (where vaccination was produced), the occurrence of bronchitis, nausea and vomiting, skin itch.
After the introduction of any multicomponent vaccine and the occurrence of side effects, the body desensitization is necessary. Symptomatic therapy is carried out. High temperatures are recommended to reduce the antipyretic agents suitable for the efficiency and form of administration, the redness of the limbs is treated with anti-inflammatory agents, allergic manifestations - antihistamine drugs. In cases of severe reactions, for example, when there is a quinque edema, you must refer to the doctor.
To avoid the emergence of complications after vaccination, it is recommended to get to the doctor's inspection. A couple of weeks before the alleged vaccination should be limited to contact with potentially patients with any kind of infections (limit stay in the collectives). It is impossible to give a child to try new food shortly before the day of vaccination, because in this case no one can say for sure that it caused a side effect, vaccination or product.
The vaccination against hemophilic infection as a whole is very well tolerated by the human body at any age. However, after it, it should be about 30 minutes to remain under the supervision of doctors to avoid the emergence of the strongest allergic reactions. Also a child is contraindicated with contact with potentially infected people, long bath procedures (better shower than a bath) and new products in the diet.
In rare cases, the vaccination against the pofaffer sticks is not carried out. This happens if the child reached the five-year-old age (the exception is the entry of a person to the risk group for this infection), has not achieved for another 3 months from the genus, if there is allergy data on vaccination components. Also vaccination is delayed in the occurrence of a sharp respiratory disease until the moment of complete recovery and restoration of immunity.
Varieties of modern vaccines
To date, the medicine market has a number of highly efficient vaccines that help protect the body from hemophilic infection.
The French Vaccine "Akt-Hib" is one-component, well-portable and, which is important, excellent compatible with other vaccines. This vaccine rarely gives reactions, mostly they are all based on allergies due to the composition of the drug.
Another French vaccine "Pentaxim" is already a multi-component, in parallel protecting the children's organism and from such terrible infectious diseases such as cough, tetanus, poliomyelitis and diphteria. Such an advantage of the vaccine determines its high price, but the quality of the drug producers hold at the highest level.
Belgian one-component vaccine against hemophilic infection "Hiberix" allows you to vaccinate a person aged 6 weeks from the genus. Such early vaccination is very necessary for children on artificial feeding.
But another Belgian Vaccine of Multicomponent Action - Infanriks Hexa - helps in protecting the human body from all the same infections as "Pentaxim", but additionally also fights hepatitis V.
The cost of such a drug is high, but the mechanism of action and efficiency - at the proper level.
Vaccination aimed at combating hemophilic infection is mandatory for all young children, since it helps protect the faster organism from such severe diseases such as meningitis, pneumonia and others with almost 100% probability.
Velvikova Nina Vladislavovna
Specialty: infectious, gastroenterologist, pulmonologist .
Common experience: 35 years .
Education: 1975-1982, 1mmi, San Gig, Higher Qualification, Infectious Physics .
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Author: Trubacheva E.S., Doctor - Clinical Pharmacologist
Today's topic concerns the next representative of the normal microflora, which under certain conditions can cause severe diseases, both in childhood and adult age. Speech will go O. Haemophilus. influenzae. , Simply put, about hemophile.
Let's start traditionally S. Microbiological aspects
Where did the name of the microorganism come from? The fact is that these small bacteria requires factors present in the blood (factors X - gemein and V - nicotine-adenine dinucleotide) for growth on chocolate agar, so they are called hemoglobinophilic bacteria or hemophilia.
H. influenzae. It is a gram-negative coccob-like bacterium colonizing the upper respiratory tract. Six types of hemophil, denoted by letters from A to F, which differ in the presence or absence of an outer capsule. W. H. influenzae. Type B (Hib) Capsule is available and is a polymer structure consisting of ribose and ribitol bonded by phosphoric acid. This capsule is the main factor pathogenicity, since thanks to her microorganism is able to effectively defend themselves from phagocytosis and activate the complement system, thereby ensuring its survival. therefore H. influenzae. Type B are the most invasive of all types of hemophil.
H. influenzae. Capable to the formation of biofilms that contribute to the survival of entire colonies, and not only individual microorganisms, as it is even more actively oppose the factors of immunity. About what biofilms are, we told here.
With all the above-described hemophils, including type B, are components of normal nasopharynx microflora. After the birth of the nasopharynk is colonized by Bedless H. influenzae. And not always this colonization leads to the development of diseases. Then, when meeting with HIB carrier, they are also treated. Further developments will depend on the state of the nasopharynx mucosa.
H. influenzae. Extremely unstable in the external environment, any disinfectant kills them instantly, so the source of the disease is only a person - a patient or carrier, and the transmission mechanism is exclusively air-drone, as the pathogens in large quantities are concentrated in the secrets of the upper respiratory tract. And if the patients do not isolate (or at least not to wear a mask on them), then everything is quickly reworked.
Especially many pathogens accumulate in saliva and the mucosa separated by sick children, which indicates the acute contagiousness (nothing reminds?). And considering the fashion of recent years to bring sick children (I will think, snot and cough) in organized groups and the absence of mandatory Hib vaccination, you can get a massive flash in kindergarten. Literary sources suggest that in Russia to 40% of meningitis in children under 5 years of age have caused HIB with mortality around 5-10% and heavy complications within 40%. At the same time, the carriage H. influenzae. Type B among children of different ages for Russia is 35-78%. In addition, in the first year of life, atpirated hemophil strains can be distinguished, contributing to the high risk of developing acute average otitis. And since, for obvious reasons, we cannot recommend disbanding the kindergarten groups to reduce the frequency of hemophil carriage, it remains only one yield - vaccination that we still have optional, and if there is a HIB component in vaccines, it is sometimes entered only under the pressure of the parents, since the nurse about its availability in the box can simply not guess (this question very brightly discussed the doctor in his blog - Pediatrician Sergey Butyria, and despite the fact that the post is written for parents, doctors also do not prevent the doctors to remember that Their destination can be read, to put it mildly, ambiguously). And is it time for the energy spent on the fight against golden staphylococcus in the noses and kale of children, to switch to the detection and sanitation of the hemophil type B at the same age? And the business will be useful, and from non-clear staphylococcus the lag.
Separately, it is worth noting that in countries with the prevailing black population (we can not even imagine where we can still read) predisposition to the carriage and development of diseases caused by H. influenzae. , as well as to mortality of children from hemophilic meningitis, even higher in view of the likely genetic susceptibility.
All diseases caused by H. influenzae. can be divided into invasive and non-invasive. Invasive Diseases are caused by capsular H. influenzae. type B, and these include pneumonia, meningitis, seps, arthritis, epigetytes and cellulites. It is important to remember that the deterrent factor for capsule H. influenzae. is the presence of mucus on the surface of the respiratory tract, and as soon as it, for some reason, disappears, hemophilas are immediately fixed on the epithelium, and since they are not subjected to phagocytosis proceed due to the presence of a capsule, it is quite quickly penetrated under the epithelium, the lymphoid Barrier and fall into the blood, causing the above diseases.
Non-invasive Diseases caused H. influenzae. , arise as a consequence of the propagation on the mucous membranes of the respiratory tract of unwashed non-drug hemophile and are complications of ARVI, which could reduce the local immune response. The attention of pediatricians is not staphylococcus, with which some are desperately fighting, and hemophile causes secondary bacterial complications if they suddenly arise.
When we need to think about H. Influenzae?
- With damage to the lungs - acute or exacerbation of chronic bronchitis (especially in smokers), community-acquired pneumonia (in children up to 10% of cases)
- The defeat of the ENT organs: in childhood it will be epigetytes, sinusites, medium otitis (both in children, and in adults), periorubital cellulites
- In bacteriamia in childhood and, possibly, rarely, bacterial endocardits
- Under the defeat of the central nervous system in children - meningitis (in adults it is extremely rare, in children immunized by HIB vaccine, almost never)
- With the damage to the musculoskeletal system - septic arthritis, osteomyelitis (in adults)
- Eye lesions - conjunctivitis
Most predisposed to the development of hemophilic infections :
- Children weakened by Rakhit and hypotrophy
- Oncological patients
- Patients with immunodeficiencies of various etiology
- Patients with sickle-cell anemia
- Perennial smokers
- Children, often sick orvi
- That is, it will be patients who initially have conditions that contribute to the weakening of the immune system, including its local responses (Nr., violation of mukicillional clearance in smokers) leading to the disclosure of the entrance gate for hemophil.
After a transferred hemophilic infection caused by HIB, a very resistant immunity with a high content of antibodies is formed. At the same time, children under two months are rarely sick, because at this moment there are maternal antibodies.
Hemophilic meningitis under the age of 5 years in 90% of cases are caused H. influenzae. Type B, while 60% of cases falls at age for up to 2 years, and proceed in the form of sepsis with a lesion of not only brain shells, but also joints, middle ear, lungs, etc.
The second extremely formidable children's hemophilic disease, which for several hours can lead to death, is acute epiglotite, it is also "croup" capable of providing complete obstruction of the respiratory tract. The cause of it is also H. influenzae. Type b.
Acute Middle Otitis, both in children and in adults, in most cases also caused H. influenzae. - mostly unpremored strains.
Frequently ill-friendly with sharp respiratory diseases of children, the cause of secondary bacterial complications is most often H. influenzae.
In addition, you should not forget about the on-community infection and the development of hemophilic fan-associated pneumonia in patients with their colonies in the nasopharynk, or infection by the unwitted hands and nurses of the resuscitation team. In this case, the early (within 2 - 4 days) fan-associated pneumonia will be developed.
Microbiological diagnostics plays a major role in disease therapy caused by H. influenzae. What methods and means can we use?
- Express diagnostics tools - detection of the capsule Hib-antigen in the spinal fluid, blood, pleural fluid and urine
- Means of microbiological diagnostics, and for this until the appointment of antibiotics need to collect all the necessary biological material - blood, urine, bronchoalveolar lavage (spindy sputum is not informative), spinal fluid, etc.
- Serology of clinical value does not have, but if you want to write scientific work and there is access to the laboratory, then it is possible
- An unexpected proposal - if you have a sharp smell, and from the patient clearly smells of mice, it can become a hint in an early, dollaborator search. True, the patient should not impress impressions as if he lives with these mice.
What to treat?
The main role in the treatment is played by the age of the patient and the localization of the process. In addition, it is necessary to remember that hemophiles, like pneumococci, can produce penicillinases than almost completely excluded from the use of unprotected forms of natural and synthetic penicillins if the patient has been used over the next half of the year.
Non-hazardous infection in adults , such as acute average otitis, exacerbation of chronic bronchitis or sinusitis can be treated according to the following schemes:
- Amoxicillin clavulanate 500 mg three times per day orally, or 875 mg twice a day.
- If there is no data on the treatment of antibiotics during the previous half year, it is possible to use amoxicillin 500 mg three times a day.
- Foreign sources recommend the use of co-trimoxasol, but the author does not want to like them at all.
- Cefuroxime 250-500 mg orally twice a day.
- Moxifloxacin 400 mg once a day or levofloxacin 500 mg once a day.
- Azitromycin (which author sincerely does not like because of the security profile) we are recommended to use 500 mg of once and then 250 mg once a day 4 days - a wild scheme caused by problems with a security profile, and if you really want macrolides, it is better Use much more secure clarithromycin - 500 mg twice a day.
The duration of treatment is:
- With acute otitis 10-14 days;
- Sinusit 10-14 days;
- The exacerbation of chronic bronchitis is 5 days for fluoroquinolones or 14 days for everyone else.
Meningitis in adults (Antibacterial therapy only)
- Ceftriaxone 2 grams intravenously every 12 hours (maximum dosage 4 g)
- Cefotaxim 2 g / every 4-6 hours (12 g maximum)
- If there is data on the presence of sensitivity, you can use ampicillin in a dose of 2 g every 4 hours intravenously
- As an alternative to Betalactama, you can use fluoroquinolones
Meningitis in children (Schemes for prematurendrients we look in the appropriate literature, or in the instructions for using the mentioned drugs)
- Cefotaxim - 200 mg / kg / day in / every 6 hours
- Ceftriaxone - 100 mg / kg in / every 12-24 hours
- Duration of treatment 10-24 days
Heavy life-degrading infections in adults , such as pneumonia, heavy cellulite, septic arthritis:
- Ceftriaxone 1-2 g in / every 12-24 hours
- Tsefotim 2 g / every 6 hours
- In the presence of sensitivity - ampicillin 2 g in / every 6 hours
- As an alternative to beta-lactam - Fluoroquinolones
In conclusion of our conversation, I would like to once again note that the basis of the prevention of severe and life-in-lawy hemophilic infections of the first years of life is to use H. influenzae. Type B - vaccines and introduction of these in the national calendar vaccinations, but for now there is no explanatory work with parents (instead of intimidating a terrible golden staphylococcal).
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