Snapshot A 6-year-old boy is brought to the pediatric emergency department after developing difficulty with breathing. Per his mother, his symptoms began approximately 3 hours ago and have progressively worsened. She endorses that he had an upper respiratory infection 1 week prior. His temperature is 102°F (38.9°C), blood pressure is 100/65 mmHg, pulse is 105/min, and respirations are 28/min. Physical examination is notable for him appearing distressed with inspiration and leaning forward with his neck hyperextended and chin thrust forward. Laryngoscopy demonstrated an erythematous and edematous epiglottis. (Epiglottitis) Introduction Classification gram-negative rod Epidemiology incidence nontypeable bacteria most commonly cause otitis media Transmission respiratory Microbiology oxidase positive facultatively anaerobic nonmotile polysaccharide capsule there are 6 types of capsules; however, type b is commonly associated with invasive disease organisms without a capsule are said to be nontypeable IgA protease Associated conditions encapsulated (type b) strains meningitis epiglottitis septic arthritis nonencapsulated strains otitis media pulmonary disease in patients with preexisting lung disease (e.g., chronic bronchitis and viral influenza infection) Prognosis haemophilus influenzae type b conjugate vaccine provides active immunization, which is important in preventing Hib infection Studies Chocolate agar requires factors V (NAD+) and X (hematin) for growth Grows near S. aureus on blood agar S. aureus supplies factor V Presentation H. influenzaeClinical PresentationDiseasePresentationDiagnostic StudiesTreatmentMeningitisSymptomsheadachenauseavomitingPhysical examnuchal rigidityBrudzinki signspontaneous flexion of the hips during passive neck flexionKernig signinability to extend the knees while the hips are flexed at 90°Lumbar punctureCeftriaxone or cefotaximeEpiglottitisSymptomsdysphagiaPhysical examdroolingfevermuffled voicestridortrunk leaning forward, neck hyperextended, and chin thrust forwardLaryngoscopyBlood and epiglottic culturesAirway protectionCeftriaxone or cefotaximeSeptic arthritisSymptomsswollen and painful jointPhysical examjoint tendernessSynovial fluid analysis and cultureCephalosporinOtitis mediaSymptomsirritabilityheadacheear painPhysical examear tugging/tuggingClinical diagnosisTympanocentesis can be considered when an etiologic diagnosis is neededAmoxicillin or amoxicillin-clavulanate H. influenzae Clinical Presentation Disease Presentation Diagnostic Studies Treatment Meningitis Symptoms headache nausea vomiting Physical exam nuchal rigidity Brudzinki sign spontaneous flexion of the hips during passive neck flexion Kernig sign inability to extend the knees while the hips are flexed at 90° Lumbar puncture Ceftriaxone or cefotaxime Epiglottitis Symptoms dysphagia Physical exam drooling fever muffled voice stridor trunk leaning forward, neck hyperextended, and chin thrust forward Laryngoscopy Blood and epiglottic cultures Airway protection Ceftriaxone or cefotaxime Septic arthritis Symptoms swollen and painful joint Physical exam joint tenderness Synovial fluid analysis and culture Cephalosporin Otitis media Symptoms irritability headache ear pain Physical exam ear tugging/tugging Clinical diagnosis Tympanocentesis can be considered when an etiologic diagnosis is needed Amoxicillin or amoxicillin-clavulanate Lumbar puncture Cephalosporin