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Septic Arthritis Due to Haemophilus influenzae Serotype f in a Patient With Waldenström Macroglobulinemia: Case Report and Review of the Literature

Carlsen, David R. MD*; Sill, Joshua M. MD; Fester, Eric W. MD; Prakash, Vidhya MD§

Infectious Diseases in Clinical Practice: May 2013 - Volume 21 - Issue 3 - p 155–158
doi: 10.1097/IPC.0b013e31827e14ac
Review Articles

Abstract: Haemophilus influenzae, a gram-negative pleomorphic bacillus, is a well- recognized pathogen in children. In recent years, it is increasingly recognized as an opportunistic pathogen in adults predominantly causing bacteremia, pneumonia, or meningitis. Impaired humoral immunity is a major factor in the development of more invasive infections. An extensive review of the literature reveals that it is infrequently identified as the etiologic agent of septic arthritis in adults. Initial management of septic arthritis includes surgical drainage and antibiotic therapy. We present a case of septic arthritis due to H influenzae serotype f in a patient with Waldenström macroglobulinemia. After surgical drainage and 3 weeks of antibiotic therapy, the patient resumed normal activity and has continued to do well after 1 year of follow-up. Physicians must be mindful of this invasive pathogen’s role in septic arthritis and the need for immediate surgical intervention and antibiotic administration so as to decrease associated morbidity and mortality.

Since the introduction of the Hib vaccine, the overall incidence of Haemophilus influenzae infection has decreased among children with a subsequent increased incidence of invasive disease in adults. A majority of invasive infections are now identified as serotype f and other nontypable strains. Carlsen et al. present a case of septic arthritis due to H.influenzae, serotype f in a patient with Waldenström macroglobulinemia. Patients with underlying immunodeficiencies are especially prone to this relatively rare phenomenon. Physicians must remain vigilant in entertaining this diagnosis in patients with immunodeficiencies so as to prevent associated morbidity and mortality.

From the *Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Wright-Patterson Medical Center, †Department of Pulmonary/Critical Care/Sleep Medicine, USAF School of Aerospace Medicine, Aeromedical Consultation Service, ‡Department of Orthopedic Surgery, Wright-Patterson Medical Center and §Department of Infectious Disease, Wright-Patterson Medical Center, Wright-Patterson AFB, OH.

Correspondence to: Vidhya Prakash, MD, Department of Infectious Disease, Wright-Patterson Medical Center, 4881 Sugar Maple Dr, Wright-Patterson AFB, OH 45433. E-mail: vidhya.prakash@wpafb.af.mil.

The authors have no funding or conflicts of interest to disclose.

Disclaimer: The views and opinions expressed in this article/presentation are those of the author and do not reflect official policy or position of the United States Air Force, Department of Defense, or US Government.

© 2013 by Lippincott Williams & Wilkins.