Invasive Haemophilus influenzae infections in older children and adults in Seattle.

We recently saw two unusual manifestations of Haemophilus influenzae infection in adults in the Seattle area: fulminant sepsis in an otherwise-healthy man and three episodes of bacteremia in a woman with chronic liver disease. We retrospectively identified 79 bacteremic and 40 non-bacteremic cases of invasive H. influenzae infection developing in patients > or = 9 years of age between 1 January 1980 and 31 December 1990. The most common clinical presentations among patients with bacteremia included pneumonia (52%), septicemia (27%), meningitis (8%), gynecologic infection (5%), and epiglottitis (5%). Underlying illnesses were common in these patients, and overall mortality was 35.5%. Factors associated with mortality included underlying neurological disease, polymicrobial bacteremia, and advanced age. The clinical presentations of the 40 patients without bacteremia included soft-tissue abscesses (45%), lung abscesses (18%), peritonitis (13%), meningitis (8%), gynecologic infection (8%), epididymitis (5%), mastoiditis (3%), and osteomyelitis (3%). Thus H. influenzae disease has a variety of presentations and is associated with significant mortality in older children and adults. Further study is required to determine whether widespread administration of H. influenzae type b conjugate vaccine to infants will alter the development of subsequent disease in later life.

Hepatitis due to herpes simplex virus in marrow-transplant recipients.

Eight cases of hepatitis due to herpes simplex virus (HSV) (five "confirmed," three "possible") were identified among marrow-transplant recipients at the Fred Hutchinson Cancer Research Center between 1975 and 1988. The clinical and pathological characteristics of these patients are described and compared with published findings for non-marrow-transplant recipients with HSV hepatitis. Clinical syndromes in the marrow-transplant recipients ranged from fever associated with abdominal pain and elevations in serum aminotransferase levels to fulminant hepatitis. Evidence of hepatic infection appeared before day 20 following transplantation unless prophylaxis with acyclovir was given, in which case HSV hepatitis did not appear until after day 40. All patients died, although the one patient who was given early, empirical high-dose acyclovir therapy clearly improved with antiviral therapy and may have died of other causes. Involvement of multiple organs with HSV was found in three of four patients with confirmed HSV hepatitis who underwent autopsy. In all cases, reactivation of latent HSV was the presumed source of the HSV hepatitis. HSV hepatitis should be considered when HSV-seropositive recipients of marrow transplants develop abdominal pain, fever, and elevations in aminotransferase levels.