Haemophilus influenzae

Question

My daughter, 1,5 years old suffers from CF and has now for the first time Haemophilus influenzae in the throat swab. Our treating CF physician regards it as a harmless germ, it is therefore not treated at the moment. I would like to have a second opinion. Of course, we do not want to give antibiotics if it is not necessary, however she suffers a lot from the increased mucus, she coughs therefore much until she vomits (what we did not experienced so far) and she eats less. We inhale more frequent with 3% saline solution. I do not know, what to do, as a bronchitis or pneumonia is not desirable, either. My question is, would you treat the germ and if not, does it disappear itself?
Many thanks

Answer

Hello,
Haemophilus influenzae is indeed harmless if there are no clinical symptoms (no infection of the lungs, the ears or the throat). At this young age however, there are often airway infections in the frame of the physiological immunisation. In this episodes, the germ is re-activated, multiplies and can potentially cause pneumonias and ear infections.
In case of good health status (no fever, no cough, no ear pain) I would in spite of this think about an eradication antibiotic treatment (get rid of the badteria) and would treat for 2 weeks with a sensitive antibiotic drug. Thorat swab and control of the CRP value are helpful.
This action is based on the knowledge, that also subclinical bronchial infections occur. We know, that often already at the age of 3 months, bronchiectasis occur. The studies, that were initiated by Prof. Kopp (Lübeck) and Prof. Mall (Heidelberg), and in which I had also 4 patients of mine, proof unfortunately, that the clinical insuspicious CF lung of a baby shows very early morphological changes.
As the child is for sure vaccinated according to the recommendations, one can suppose, that the infections with HI are not so aggressive.
We know from the study of Prof. Kahl (Münster): "Factors Associated with Worse Lung Function in Cystic Fibrosis Patients with Persistent Staphylococcus aureus - PLOS ONE | I:10.1371/journal.pone.0166220 November 18, 2016 1 / 18", that a high bacterial load in case of Staphyloccus aureus can be a problem for lung development. I myself took part in the study and can confirm the message with my experiences. From the standpoint of research this is true for Staphylococcus aureus.
Investigations about colonization and infections with Hämophilus influenzae are not known to me. Nevertheless I can imagine a similar mechanism.
In case of doubt, if there are clinical signs, I would always treat in case of CF.
Now one can read from your question, that your child has marked sings of clinical infection. In my opinion an antibiotic therapy has to be initiated in this case! In my opinion, also an anti-inflammatory and mucolytic therapy with dornase-alpha (Pulmozyme) off-label has to be discussed.
The chance of slowing down the ongoing lung destruction at this young age is real!
Please discuss this with your CF physician in charge, as he knows the overall situation best.
Best regards,
Dr. H.-E. Heuer

17.03.2017