mierre ’ s syndrome but had no evidence of thrombophlebitis of the internal jugular vein .
There has been a drastic decline in invasive disease caused by H . influenzae in recent decades . However , as a regular inhabitant of the human respiratory tract , it is important to consider as a cause of descending local infection . This report highlights the importance of continued awareness of serious invasive H . influenzae disease . Increasing literature on this topic will hopefully improve prompt recognition of dangerous pharyngeal infection .
Figure 2 : CT chest showing bilateral pleural effusions ( red arrows ) and pericardial effusion ( yellow arrow ).
Transthoracic echocardiogram raised suspicion for a complex pericardial effusion , which was confirmed by transesophageal echocardiogram . There was no evidence of tamponade physiology . A pericardial window was performed , and the effusion was evacuated . The patient had a prolonged ICU course , with eventual liberation from mechanical ventilation and slow recovery . The patient was discharged to rehab and then home .
Discussion and Conclusions
Since the advent of the Hib conjugate vaccine in 1985 , H . influenzae has declined as a major cause of bacterial meningitis to a culprit of noninvasive , acute upper respiratory infections . Among those still affected by invasive H . influenzae disease , the most common presentation is in children < 1 year of age and adults aged > 65 years . 3 Most recent data shows the incidence of invasive Hib disease in adults and children > 5 years of age is < 0.05 per 100,000 . 3 The vaccination status of our patient is unknown , but she has no known risk factors for serious infection , including immunodeficiency , asplenia , HIV infection , or history of hematopoietic stem cell transplant . 2 In a 36-year-old patient , this is a very rare case of an already rare disease .
H . influenzae is an uncommon cause of thrombophlebitis , with only one documented case in the literature . This report , published in 1984 , focuses on an adolescent male with common variable immunodeficiency disease who developed septic thrombophlebitis caused by H . influenzae following the use of a scalp vein needle . 4 This patient differs from ours in that he had known immunocompromise and was unvaccinated against Hib . Additionally , he developed the disease after the use of an intravenous needle , a known risk factor for thrombophlebitis .
Septic thrombophlebitis is more widely known as Lemierre ’ s syndrome when it involves the internal jugular vein and is usually caused by anaerobic Fusobacterium species . This syndrome has been increasing in incidence over the last several years , due in part to the recent decrease in treatment of pharyngitis with antibiotics , along with Fusobacterium as an often-overlooked cause of pharyngitis in young healthy patients . 5 Our patient ’ s presentation was highly suggestive of Le-
References
1 . Van Hoecke F , Lamont B , Van Leemput A , et al . A Lemierre-like syndrome caused by Staphylococcus aureus : an emerg-ing disease . Infectious Diseases . 2019 ; 21:1-9
2 . Briere EC , Rubin L , Moro PL , et al . Prevention and control of Haemophilus influenzae type b disease : recommendations of the advisory committee on immunization practices ( ACIP ). MMWR Recommendations and Reports . 2014 ; 63:1-14
3 . Soeters HM , Blain A , Pondo T , et al . Current Epidemiology and Trends in Invasive Haemophilus Influenzae Disease-United States 2009-2015 . Clinical Infectious Disease . 2018 ; 67:881-889
4 . Ahonkhai V , Bhasin Y , Fikrig S , et al . Haemophilus Influenzae Septic Thrombophlebitis Following Use of a “ Scalp-Vein ” Needle . Journal of the National Medical Association . 1984 ; 76:196-198
5 . Osowicki J , Kapur S , Phuong LK , et al . The long shadow of Lemierre ’ s syndrome . Journal of Infection . 2017 ; 74 : S47-S53
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