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Key Features

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  • • Cause sinusitis, otitis, bronchitis, epiglottitis, pneumonitis, cellulitis, arthritis, meningitis, and endocarditis

    • Risk factors

    • – Alcoholism

      – Smoking

      – Chronic lung disease

      – Advanced age

      – HIV infection

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Clinical Findings

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  • • Typical bacterial pneumonia, with purulent sputum containing a predominance of gram-negative, pleomorphic rods

    Epiglottitis is characterized by an abrupt onset of fever, drooling, and inability to handle secretions

    • – Often a severe sore throat despite an unimpressive examination of the pharynx

      – Stridor and respiratory distress result from laryngeal obstruction

    Meningitis with sinusitis or otitis

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Diagnosis

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  • • Culture

    • Haemophilus species frequently colonize the upper respiratory tract

      – In the absence of positive pleural fluid or blood cultures, distinguishing pneumonia from colonization or from bacterial bronchitis is difficult

    • Epiglottitis: The diagnosis is best made by direct visualization of the cherry-red, swollen epiglottis at laryngoscopy

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Treatment

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  • • For patients with sinusitis, otitis, or respiratory tract infection

    • – Amoxicillin, 500–875 mg twice daily orally (not effective for β-lactam–producing strains) for 10–14 days

      – Amoxicillin/clavulanate, 875 mg/125 mg twice daily orally for 10–14 days

      – Levofloxacin, 500 mg once daily for 10–14 days

    • For patients with penicillin allergy

    • – Oral cefuroxime axetil, 250 mg twice daily for 7 days or

      – An oral fluoroquinolone (ciprofloxacin, 500 mg twice daily; levofloxacin, 500–750 mg once daily; or moxifloxacin, 400 mg once daily) for 7 days

      – When a macrolide is the preferred agent, azithromycin, 500 mg orally once followed by 250 mg daily for 4 days, is preferred over clarithromycin

      – Oral trimethoprim-sulfamethoxazole, 160/800 mg twice daily, can be considered but resistance rates have been reported as high as 25%

    • In the seriously ill patient use ceftriaxone, 1 g/d, pending organism susceptibilities

    H influenzae meningitis

    • – Initiate therapy with ceftriaxone, 4 g/d in two divided doses, until the strain is proved not to produce β-lactamase (Table 30–5). Meningitis is treated for 10–14 days

      – Dexamethasone, 0.15 mg/kg intravenously every 6 hours may reduce the incidence of long-term sequelae, principally hearing loss

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Content adapted from CURRENT Medical Diagnosis & Treatment 2014.

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Key Features

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Essentials of Diagnosis

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  • • Absence of skull fracture does not exclude the possibility of severe head injury

    • In many elderly patients, there may not be a known history of head trauma

    • Occasionally, head injury, often trivial, precedes symptoms by several weeks

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General Considerations

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  • • Some guide to prognosis is provided by the mental status

    • – Loss of consciousness for more than 1 or 2 min implies a worse prognosis than otherwise

    • The degree of retrograde and posttraumatic amnesia provides an indication of the severity of injury and thus of the prognosis

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Demographics

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