Hemophilus influenzae type b pneumonia.

SUMMARY Thirteen patients with Haemophilus influenzae type b pneumonia are reported to emphasise the clinical, radiographic, and therapeutic aspects of this illness. All but one patient was tnder 21 years of age. The presenting complaint was a variable duration of upper respiratory infection and fever in most cases. One-third of patients had radiographic evidence of pleural involvement ; one-third showed a patchy bronchopneumonia on roentgenogram; and the remainder had segmental or lobar infiltrates. Clinical response to antibiotic therapy was prompt in patients without pleural involvement. The relative importance of Haemophilus influenzae type b as a pulmonary pathogen in the antibiotic era is unknown. Since 1955, reports have stressed the rarity of primary H. influenzae type b pneumonia with or without empyema (Nyhan et al. note that pneumonia and empyema due to H. influenzae type b may be clinically and radiographically indistinguishable from pneu-mococcal pneumonia. Furthermore, the apparent therapeutic responses of patients with pneumonia to penicillin may not distinguish between these two aetiological agents (Honig et al., 1973). Our recent experience with 13 patients is presented to emphasise the clinical, radiographic, and therapeutic aspects of H. influenzae type b pneumonia. Case reports The case histories of the 13 patients (8 boys, 5 girls) with H. influenzae type b pneumonia are summarised in the Table. They all presented during a 4-year period, 1972-1976. Diagnosis was based on the recovery of H. influenzae type b from the culture of blood or pleural fluid in a patient with pulmonary infiltrates on roentgenogram. These patients were not evaluated for simultaneous viral infection by either cultures or serology. None of the patients had any other focus of infection. 12 of the 13 patients were under 21 years of age. The white blood cell count was >12 0 x 109/l for all, but the differential counts were variable. The presenting complaints varied Received 25 August 1977 from a preceding upper respiratory infection of 1 day to 3 weeks' duration in 12 patients, to acute onset of fever and right-sided chest pain in 1. Four patients had radiographic evidence of pleural involvement; diagnostic thoracentesis performed in 3 showed empyema in each. Closed thoracotomy drainage was necessary in only one patient (Case 3) because of reaccumulation of fluid and continued fever. 2 patients (Cases 1, 3) did not become afebrile until after 2 weeks and were discharged with persistent pleural reaction. Subsequently , both have had complete resolution of …