Monica M. Farley, MD; David S. Stephens, MD; Philip S. Brachman Jr., MD; R. Christopher Harvey, MPH; J. David Smith, BS; Jay D. Wenger, MD; CDC Meningitis Surveillance Group*
▪ Objective: To define the incidence of and possible risk factors for invasive Haemophilus influenzae disease in adults.
▪ Design: Prospective, population-based surveillance of hospital and referral bacteriology laboratories.
▪ Setting: Metropolitan Atlanta, Georgia community.
▪ Patients: All patients with H. influenzae isolated from normally sterile sites (blood, cerebrospinal fluid, joint, pleura) from 1 December 1988 through 31 May 1990.
▪ Measurements: Isolates of H. influenzae were analyzed for serotype and biotype status, outer membrane proteins, lipooligosaccharide phenotypes, ribotyping patterns and β-lactamase production.
▪ Results: A total of 194 cases of invasive H. influenzae occurred (annual incidence of 5.6 cases/100 000 population), of which 47 (24%) were in adults 18 years old or older (annual incidence 1.7 cases/100 000 adults). Adults with invasive H. influenzae ranged from 18 to 96 years; 79% were women. Bacteremic pneumonia accounted for 70% of the adult cases. Other sources for invasive H. influenzae in adults were obstetric infections, epiglottitis, and tracheobronchitis; one patient had meningitis. Underlying conditions were noted in 92% of the patients. Chronic lung disease was the most common risk factor, but pregnancy (annual incidence, 4.9/100 000 pregnant women), HIV infection (annual incidence, 41/100 000 known HIV-infected adults), and malignancy were also important. Overall mortality was 28% in adults, and over half of pregnancy-related infections resulted in fetal death. Fifty percent of the 40 isolates available for testing were serotype b; 47.5%, nontypable; and 2.5%, serotype f. Sixteen of the 45 isolates (36%) were ampicillin-resistant. Based on biotypes, outer membrane protein profiles, lipooligosaccharide phenotypes, and ribotyping patterns, the type b isolates showed less heterogeneity than the nontypable isolates but were distinguishable from one another.
▪ Conclusions: Adult cases currently represent one quarter of all cases of invasive H. influenzae disease. Half of the reported adult cases were caused by type b H. influenzae, and the rate of ampicillin resistance in H. influenzae isolates from adults was higher than previously reported. Haemophilus influenzae is an important cause of bacteremia in compromised adults.
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Farley MM, Stephens DS, Brachman PS, Harvey RC, Smith JD, Wenger JD, et al. Invasive Haemophilus influenzae Disease in Adults: A Prospective, Population-based Surveillance. Ann Intern Med. 1992;116:806–812. doi: 10.7326/0003-4819-116-10-806
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Published: Ann Intern Med. 1992;116(10):806-812.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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