헤모필루스 인플루엔자에 대한 이해: 주요 특징 및 감염

### 헤모필루스 인플루엔자에 대한 이해: 주요 특징, 감염 및 치료법
* 🦠 *헤모필루스 인플루엔자*는 초콜릿 한천에서 또는 *황색포도상구균*이 있는 상태에서 성장하기 위해 **용혈 인자, 특히 V 인자(NAD)와 X 인자(헤마틴)**가 필요한 그람음성 구균균입니다.
* 이 박테리아는 비인두에 서식하며 에어로졸화된 비말을 통해 전염되며, 특히 **캡슐화되지 않은 균주가 가장 흔한 감염 원인**으로, **캡슐화 균주를 감소시킨 백신이 도입된 이후**에는 더욱 그렇습니다.
* 💡 *H. 인플루엔자*는 혐기성 및 비운동성 유기체로, **1800년대 후반에 유행성 인플루엔자를 일으킨다는 오해**로 인해 이름이 붙여졌습니다.
* 🔬 독성 인자로는 점막 방어를 회피할 수 있는 **IgA 프로테아제**와 무력증 환자에게 위험을 초래하여 심각한 감염을 유발하는 **다당류 캡슐**이 있습니다.
* 🤒 감염의 임상적 특징으로는 **후두개염, 중이염, 부비동염, 폐렴**과 같은 점막 표면 감염이 있으며, 특히 **후두개염은 시험에 자주 출제되는 주제**입니다.
* 📈 후두개염의 증상으로는 **발열, 침 흘림, 연하곤란, 호흡곤란, 환자가 호흡을 편하게 하기 위해 몸을 앞으로 숙이는 전형적인 증상인 삼각자세** 등이 있습니다.
* 측면 엑스레이의 엄지손가락 모양은 **후두개염의 주요 영상 소견**으로, 뾰족한 모양을 보이는 **크룹과 구별**할 수 있습니다.
* 💊 점막 감염은 **아목시실린과 클라불라네이트**, 수막염은 **세프트리악손**, 밀접 접촉자는 **예방적 리팜핀**으로 치료해야 합니다.

* 헤모필루스 인플루엔자*는 후두개염과 같은 감염을 일으키는 그람음성 구균으로 특정 성장 인자를 필요로 합니다.

In this video, we'll talk briefly about *Haemophilus influenzae*. This will probably be a quick video, and there's just a few high-yield things that you need to know, which I will really harp on. First, *H. influenzae*'s defining characteristics are

that it is a gram-negative coccobacillus. It grows on chocolate agar, which is sort of high-yield because examiners like you to know that in order for *H. influenzae* to grow, it requires hemolytic factors, and specifically it requires V factor or NAD and X factor or

hematin. So, you can either grow it on chocolate agar, or you can grow it in the presence of *Staphylococcus aureus*, and the *Staphylococcus aureus* itself being hemolytic will create those factors that the *H. influenzae* needs to grow. So, first high

yield point is that you should know that it grows on chocolate agar because chocolate agar contains those hemolytic factors. But, you should also know that if you can't grow it on chocolate agar, you can simply grow it in the presence of *Staphylococcus aureus* because *Staphylococcus aureus* is a

substitute that in and of itself will produce those hemolytic factors. That does show up on exams. So, please know that *H. influenzae* colonizes the nasopharynx. It is transmitted via aerosolized transmission. Unencapsulated strains are the most

common cause of infection. Now, to be clear, there are both unencapsulated strains and capsulated strains. If you've watched the previous video on *Neisseria*, then we already talked about opsonic and how asplenic patients are really at risk of infection with encapsulated

bacteria and *Haemophilus influenzae* is one of those encapsulated bacteria but since the introduction of the vaccine against *H. influenzae*, those capsulated strains have pretty much been eradicated and therefore the majority of infections are caused by the unencapsulated strains

which the vaccine does not prevent against. Lastly, *H. influenzae* is a facultative anaerobe and it is non-motile. A little cool aside here, this doesn't show up on exams of course, but the reason that this is called *H. influenzae* is because this bacteria was actually

discovered in the late 1800s during an influenza pandemic and the person that discovered it thought that this was the bacteria that caused the common flu and that's why this bacteria retained the name influenza in the name. So pretty

cool aside. You might impress somebody if you tell them that. Here's an image of *H. influenzae* again. The thing that I want to call your attention to is that it is a gram-negative coccobacillus, so keep that in mind. Virulence factors: if you've

watched the recent video that I posted on *Neisseria*, this really isn't a big surprise because it's similar. So first we have IgA protease and recall that IgA is very important for immunity and defense at mucosal surfaces. So bacteria

that have an IgA protease and can cleave that defense basically are going to cause infections at mucosal surfaces and as you'll see on the next slide, *H. influenzae* causes epiglottitis, otitis media, sinusitis, pneumonia, basically upper respiratory infections.

and it gets in at those mucous surfaces that's what IgA protease is doing the more high yield thing and just like we talked about in the Neisseria video is the presence of a polysaccharide capsule this causes concern for patients who don't have a

spleen or are functionally asplenic again we're concerned about overwhelming post splenectomy infection the polysaccharide capsule and I'm repeating myself so if you've watched the Neisseria video you've already heard

this but it's very very high yield and please see that video for a full pathophysiological explanation but the polysaccharide capsule allows the bacteria to evade the two-step process of opsonization and phagocytosis and so

in patients with no spleen who don't have those splenic macrophages this bacteria can cause an invasive and overwhelming infection now let's talk about the clinical features as I've already touched on there are really two types here one there are your mucosal surface

infections so the IgA protease in the bacteria is allowing it to infect the epiglottis the meninges the ear the upper respiratory system so this causes sinusitis pneumonia otitis media meningitis and epiglottitis okay so

that's what you want to keep in mind for mucosal infections and after somebody's infected with a mucosal infection the infection can become invasive so it can spread to other areas of the body this is really um less common so it's not something

that I would necessarily look for on your exam but just know that with any infection once there's a mucosal surface infection that obviously has the ability to spread now the big thing that I want to call your attention to and probably the most high-yield part of this video

is epiglottitis now epiglottitis is going to be caused by *Haemophilus influenzae* if it's happening on your exam and the way that they're going to give this to you is they're going to give you a presentation of epiglottitis and expect

you to then connect it to the causative bacteria so how I've seen this come up is that they're going to describe epiglottitis to you and then ask you what is the causative bacteria the answer obviously being *Haemophilus influenzae* but

in order to get that third order question correct you obviously need to know what epiglottitis looks like so let's talk about that now epiglottitis is extremely high yield on exams because it's got a lot of very distinct clinical

features and it also has a very famous imaging finding now let's start with symptoms so you're going to see fever you're you're going to see drooling because epiglottitis means inflammation in the epiglottis so with that being so

inflamed you're not able to swallow properly so we're going to see drooling we're going to see dysphagia and muffled voice because imagine that suddenly in the back of your throat your epiglottis is now hugely inflamed you're obviously

not going to be able to phonate like you normally do, we're going to see both stridor and respiratory retractions because now suddenly with an inflamed epiglottis we can't move air as efficiently as we previously could, and the highest yield clinical symptom that

I want to call your attention to because it shows up on exams all the time is what's referred to as the tripod position. So usually on your exam this is going to be in a child and they're going to be sitting up on their hands, usually

with their tongue out and their head forward. This is a position that the patient will automatically assume because they are trying to make it more comfortable for themselves to breathe and to be able to communicate, but mostly to breathe. And so this is called the tripod position, and so if you're taking

your exam and they describe the way that somebody is sitting, specifically in a child or adolescent patient, the bells need to be ringing in your head that they're trying to tell you this patient has epiglottitis. So again, this is referred to as the tripod position, maybe

they'll show you a picture, but more likely they're going to just describe it to you. So sitting up on their hands, tongue usually protracted or out a little bit, head bent forward, that's the tripod position. It's just a position that's more comfortable to be in if

you've got an inflamed epiglottis. Now they could describe these symptoms to you, and chances are they will, but they also could just show you imaging. If you see what's known as a thumbprint sign, you want to be thinking epiglottitis and

how this will look is you're going to get a lateral x-ray as you see here in this image and because of the inflammation in the epiglottis it looks like a thumb now please go ahead and Google thumbprint sign so you can see

various images of what this looks like because it's a very characteristic finding you want to know thumb print sign equals epiglottitis but something that's really important for test taking purposes is if you have a child patient in your vignette who has fever and some

respiratory symptoms and they show you Imaging if you have absolutely no idea what you're looking at and you're not sure what the diagnosis is or what the causative agent is you probably want to immediately narrow your differential to either epiglottitis or croup and the

reason that I say that is because epiglottitis has the characteristic thumbprint sign and croup has the characteristic steeple sign so in a child patient with fever respiratory symptoms and some type of Imaging in your question even if you have

absolutely no idea what you're looking at I would always be guessing either epiglottitis or croup because they wouldn't be giving you any Imaging if it wasn't either a thumbprint sign or a steeple sign so that's just a little

test taking strategy you have a 50% chance of getting the question correct if you approach it like how I just said lastly if you're taking step two or step three they could take this one step further and ask you what is the most

immediate next step or you know what's the appropriate which of the following is the most appropriate immediate action to take and if it's epiglottitis chances are the question is going to ask you this and the answer will be endotracheal

intubation because in somebody who has epiglottitis you want to protect their airway before you progress with further treatment now speaking of treatment let's conclude by talking about how you treat H influenza the treatment in the mucosal infections will be

amoxicillin plus clavulanate okay but if the patient has meningitis then you add in Ceftriaxone and lastly for close contacts you need to give them prophylactic Rifampin so there's three different answers here it depends on the

type of infection right either amoxicillin plus clavulanate in the mucosal infections or Ceftriaxone in your meningitis patients and then lastly if they ask you what to give to the close contacts of somebody who has H

Haemophilus Influenzae

Dirty Medicine

헤모필루스 인플루엔자*의 특성 및 성장 요건 정의

성장을 위해 용혈 인자(V 인자/NAD 및 X 인자/헤틴)가 필요합니다.

용혈 인자의 존재로 인해 초콜릿 한천에서 자랍니다.

필요한 용혈 인자를 생성하는 *황색포도상구균*이 존재할 경우 증식할 수 있습니다.

비인두에 서식하며 에어로졸을 통해 전염됩니다.

H. 인플루엔자* 균주의 종류 및 독성 인자

캡슐화되지 않은 균주는 감염의 가장 흔한 원인입니다.

백신 접종으로 인해 캡슐화된 균주가 대부분 박멸되었습니다.

IgA 프로테아제를 생성하여 점막 표면에서 감염을 허용합니다.

다당류 캡슐은 무형성 환자의 위험을 증가시킵니다.

H. 인플루엔자*로 인한 임상적 특징 및 감염

점막 감염: 후두개염, 중이염, 부비동염, 폐렴.

침습성 감염은 점막 부위에서 퍼질 수 있으며, 흔하지는 않습니다.

*H. 인플루엔자*는 후두개염의 원인균입니다.

증상: 발열, 침 흘림, 연하곤란, 쉰 목소리, 호흡곤란, 호흡수축.

삼각대 위치: 환자의 특징적인 자세.

측면 엑스레이에 엄지손가락 지문 표시.

크룹(첨탑 표시)으로 감별 진단합니다.

후두개염에 대한 즉각적인 조치: 기관 내 삽관.

점막 감염: 아목시실린과 클라불라네이트.

수막염: 세프트리악손을 추가합니다.

밀접 접촉자에 대한 예방: 리팜핀.