SHM Converge Scientific Abstract ePoster Gallery-Increasing Prevalence of an Uncommon Disease in Elderly

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This case describes a 71-year-old woman with hypertension who presented after 2 days of nausea, non-bloody vomiting, lightheadedness, and a fall. She had no abdominal pain, diarrhea, focal neurologic deficits, or loss of consciousness. She worked in a kindergarten with sick children, suggesting a possible exposure source. On arrival, she was mildly hypotensive and tachycardic, with a chest X-ray showing cardiomegaly, pulmonary vascular congestion, and a left basilar opacity. Initial workup showed mild troponin elevation and elevated BNP, and her symptoms were first attributed to gastroenteritis-related dehydration, acute kidney injury, near syncope, and type 2 myocardial injury.<br /><br />Although she initially improved with supportive care, her condition worsened on hospital day 3 with persistent lethargy and new neck pain, raising concern for meningoencephalitis. She later developed hypoxia and tachypnea, requiring ICU transfer and BiPAP. A repeat chest X-ray showed a right lower lobe infiltrate. Lumbar puncture revealed cerebrospinal fluid PCR positive for Haemophilus influenzae, and blood cultures grew H. influenzae serotype a (Hia), confirming invasive H. influenzae infection. She was treated with ceftriaxone, improved clinically, returned to baseline mental status, and was discharged to subacute rehabilitation.<br /><br />The report highlights the increasing prevalence of invasive non-type b H. influenzae infections, especially Hia, in older adults. In patients over 50, pneumonia is the most common manifestation, but meningitis/meningoencephalitis can also occur. The authors emphasize that elderly patients with respiratory symptoms and possible meningoencephalitis—particularly those with close contact with children—should prompt suspicion for invasive H. influenzae disease. Early chest CT may also be helpful when infection is suspected despite an initial chest X-ray that is not definitive.

Asset Subtitle

Yuhong Yang

Meta Tag

Author List Dahlia Rizk, Ming Jie Jiang, Yuhong Yang

Category Clinical Vignettes

Concept Haemophilus influenzae infection

Concept Invasive Infection

Concept Non-type b Haemophilus influenzae

Concept Serotype a

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization Mount Sinai West Hospital

Presenting Author Yuhong Yang

Track Adult

Keywords

Haemophilus influenzae

H. influenzae serotype a

invasive H. influenzae infection

meningoencephalitis

pneumonia

older adults

ceftriaxone

blood culture

lumbar puncture

kindergarten exposure

Haemophilus influenzae infection

Invasive Infection

Non-type b Haemophilus influenzae

Serotype a

Blood Culture