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ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Potentially life-threatening emergency
Invasive Haemophilus influenzae infection
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Invasive Haemophilus influenzae infection

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Contributors: Yoshihiko Murata MD, PhD, William Bonnez MD
Other Resources UpToDate PubMed


Invasive infections caused by Haemophilus influenzae are typically serious or life-threatening and include meningitis, epiglottitis, pneumonia, bacteremia / sepsis, septic arthritis, osteomyelitis, pericarditis, and cellulitis.

Haemophilus influenzae is a pleomorphic gram-negative bacterium that is either encapsulated (typeable) or unencapsulated (nontypeable). Six antigenically distinct capsulated strains (types a-f) can cause invasive disease among persons of all age groups. In contrast, nontypeable strains only occasionally cause bacteremia and invasive infections in adults, particularly the elderly and those with underlying cardiopulmonary and/or immunocompromised conditions.

Humans are the only known hosts of H. influenzae. Person-to-person transmission occurs by direct contact with secretions or with airborne droplet particles. Prior to the advent of effective vaccines, H. influenzae type b (Hib) was responsible for >95% of all invasive H. influenzae disease and was the leading cause of bacterial meningitis in the United States in children younger than 5 years of age. From 1989 to 2000, there was a strong correlation between the introduction and implementation of Hib-conjugated vaccines in infants and young children and the striking (99%) decline in the incidence of Hib invasive disease among children younger than 5.

Clinical manifestations of invasive diseases associated with H. influenzae reflect the organ systems affected by the infection; for example:
  • Meningitis can be preceded by an upper respiratory tract infection and presents with fever, nuchal rigidity, and/or altered mental function.
  • Invasive disease can also present initially as a localized infection, such as cellulitis, with erythema, induration, pain, and tenderness and progress to bacteremia and fulminant sepsis and hypotension.
  • Sequelae of bacteremia and disseminated invasive disease include septic arthritis, osteomyelitis, and/or pericarditis.
  • One of the most significant presentations of invasive H. influenzae disease is epiglottitis, which requires prompt diagnosis and management because of its fulminant onset and high rate of complications.
Epiglottitis – the typical patient is a young child aged 2-7 (although adults can also present with similar symptoms) who presents acutely with fever, sore throat, and progressive dyspnea and dysphagia with pooling of oral secretions and drooling of saliva. Erythema and swelling of the epiglottis is present. Note that laryngeal examination should only be performed in settings in which adequate and prompt airway management is feasible.

Pediatric Patient Considerations:
Epiglottitis usually occurs in a child aged 2-7 years.

Immunocompromised Patient Considerations:
Hib is the second most common organism associated with infections in post-splenectomy patients. Patients with underlying diseases that cause functional asplenia, eg, sickle cell anemia, are also at increased risk of invasive H. influenzae infection.


B96.3 – Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere

406583002  – Invasive Haemophilus influenzae Infection

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Differential Diagnosis & Pitfalls

Meningitis – on the basis of clinical presentation, meningitis caused by invasive H. influenzae appears to be indistinguishable from that caused by other bacteria (eg, Streptococcus pneumoniae). Differential diagnosis should include viral (eg, herpes simplex virus), fungal, and mycobacterial diseases as deemed clinically relevant.


Viral pharyngitis / tonsillitis

Respiratory diphtheria – develops more indolently; indirect laryngoscopy reveals a gray-white adherent, membranous exudate that causes bleeding on removal.

Infectious mononucleosis – membranous exudate remains on tonsils, appears whitish, and does not bleed on removal.

Vincent angina – typically involves the gums, and gram stain of necrotic pharyngeal lesions reveals polymicrobial flora, including gram-negative anaerobes and spirochetes.

Other bacterial upper airway infections (especially group A Streptococcus)

Pneumonia, bacteremia, septic arthritis – may be clinically indistinguishable from other bacterial infections (eg, pneumonias caused by S. pneumoniae or Staphylococcus aureus).

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Last Updated: 06/11/2014
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Potentially life-threatening emergency
Invasive Haemophilus influenzae infection
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Invasive Haemophilus influenzae infection (Types of Invasive Infection)
Copyright © 2018 VisualDx®. All rights reserved.