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Haemolytic–uraemic syndrome 

Haemolytic–uraemic syndrome
Chapter:
Haemolytic–uraemic syndrome
DOI:
10.1093/med/9780198729228.003.0068
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date: 19 November 2019

Haemophilus influenzae can be differentiated, according to its capsular polysaccharide composition, into six serotypes (Hia to Hif) or can be non-encapsulated. H. influenzae serotype b (Hib) is the most virulent and, prior to routine immunization, was responsible for the majority of invasive H. influenzae infections, especially in children younger than 5 years, where it was the commonest cause of acute bacterial meningitis. Other clinical presentation of invasive Hib disease include septicaemia, epiglottitis, and pneumonia, as well as bone, joint, skin, and soft tissue infections. Countries that introduced the Hib conjugate vaccine into their national childhood immunization programme have observed a rapid and sustained decline in invasive Hib disease across all age groups through direct and indirect (herd) protection. Nearly all invasive H. influenzae cases are now due to non-encapsulated H. influenzae. Invasive H. influenzae disease in pregnant women and neonates is nearly always due to non-encapsulated H. influenzae. Occasional cases of invasive Hib disease do still occur, even in immunized children who should be assessed for possible underlying immune deficiency after recovering from their infection. Diagnosis relies on isolation of H. influenzae from a normally sterile site and serotype confirmation by a validated laboratory. Intravenous third-generation cephalosporins, including cefotaxime and ceftriaxone, are the empiric treatment of choice for suspected invasive bacterial infections and are highly effective against all H. influenzae, including Hib. Household contacts are at increased risk of developing invasive Hib disease and should be offered chemoprophylaxis as soon as possible after the index case is diagnosed.

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