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HAEMOPHILUS INFLUENZAE, THE PREDOMINANT CAUSE OF BACTERIAL PNEUMONIA IN HAWAII

Streptococcus pneumoniae is considered the most common cause of bacterial pneumonia in childhood. However, in the last 5 years in our hospital Haemophilus influenzae was the most common etiology. Cases were not considered to be of bacterial etiology unless there was a positive culture from blood or body tissue such as pleural fluid or CSF. Throat, sputum, or peroral tracheal aspirate cultures were not included. Haemophilus influenzae was identified in 13/23 patients with bacterial pneumonias followed by S. pneumoniae (4/23), Staphylococcus aureus (2/23), and other bacteria (4/23). The mean age of patients with H. influenzae was 1.7 years with a sex ratio of 10 boys to 3 girls. Lobar pneumonia was most common, and 7/13 had more than one lobe involved. Haemophilus influenzae pneumonia was clinically indistinguishable from other bacterial or viral infections. Two patients had effusions, and one had an interstitial pneumonitis. The diagnosis in 10/13 cases was made by positive blood cultures. Five of 13 patients received antibiotics prior to diagnosis. Whether the incidence of H. influenzae pneumonia has increased or whether aggressive and fastidious culturing has just identified more cases is not clear. Haemophilus influenzae should not be considered an uncommon cause of pneumonia in infants and young children, and empiric therapy should cover this organism.