Need H. Influenza info! - Mothering Forums

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Old 04-24-2008, 11:26 PM - Thread Starter
 
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Long preamble to this question...sorry...

My son, Connor, is special needs with a very complicated medical history including a primary immune deficiency. The infectious disease dr has instructed us not to immunize with any of the viral vaccines due to his low t-cell count. But he did recommend all the bacterial vaxes. I declined for various reasons (except Synagis, RSV immunoglobulin, which he got once a month throughout RSV season, yet at the very end of the season he still contracted RSV, thankfully a somewhat mild case)

He has a severe ear infection that we haven't been able to kick for over 6 weeks now. He has palatal dysfunction which allows fluids to backflow into his sinus cavity, then has reflux of his eustacian tubes which allows his sinuses to backflow into his ears, then he has malformed ear drums and canals which traps the fluid in there. He had tubes put in on Feb 22nd and has basically had an infection since.

They finally cultured the infection since none of the "regular" abx were working (he was on Ciprodex drops, then Amox, then Rochephin...for 3 weeks it seemed all was well, then infection was back, so Cipro again, then Augmentin...ear was still draining green puss)

The culture came back positive for h. influenza. The nurse couldn't tell me which strain, but she did say it was [something] negative (I asked her to spell it, but I was on my cell and had a bad connection). She said the culture showed that the infection is susceptible to all the abx he's been on already. Yet the infection is still there.

We are waiting for the fungal culture to come still, because it's possible he has a fungal infection also, and that is why the abx aren't working against the bacteria.

SO...the reason I'm posting this in the vax board... I *know* that I'm going to have a fight on my hands from the infectious disease dr and possibly from the ENT about the Hib vax. Regardless of the strain of this infection, they are going to bring up the issue. So, I'm looking for the following info:

1. How many strains of h. influenza are there?
2. Which strains are covered by the vax? (only b?)
3. I've seen links before to rates of infection of each of the strains that supposedly show that since the introduction of Hib vax, other strains have taken the place of the b strain, so that the overall rates of h. influenza are unchanged...can I have that (those) link(s) please?
4. Any BTDT advice on how to handle this current h. influenza infection?? We have to treat the infection, his immune deficiency puts him at risk of serious complications, he already has hearing loss and a severe speech delay so I'm very cautious with all things regarding his ear, and repeated infections of any kind are taxing on his little body which has already been through so much. So although most kids can "ride out" an ear infection, he can't. I have to treat it...but obviously what we're doing isn't working!!

Thanks all!

Mommy to BigBoy Ian (3-17-05) ; LittleBoy Connor (3-3-07) (DiGeorge/VCFS):; BabyBoy Gavin (10-3-09) x3 AngelBaby (1-7-06)
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Old 04-24-2008, 11:30 PM - Thread Starter
 
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I just looked it up...the nurse said it is beta-lactamase negative...whatever that means! Off to research more...

Mommy to BigBoy Ian (3-17-05) ; LittleBoy Connor (3-3-07) (DiGeorge/VCFS):; BabyBoy Gavin (10-3-09) x3 AngelBaby (1-7-06)
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Old 04-24-2008, 11:52 PM
 
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Okay, so what I understand is that he has h. influenzae...unsure what type.

Beta-lactamase negative is a description...basically what that means is that the bacteria (in his case H. influenzae) is resistant (or does not respond) to certian types of antibiotics. THAT would be the reason he's not responding.. they need to give him antibiotics that do not contain beta-lactam.


The only Hi strain covered by the vax is Hi type b. Even if it is Hi type b (which I seriously doubt...I'm thinking non-typeable) a vax wouldn't help now.

I would give heavy duty probiotics and get him on a serious dose of antibiotics that do not contain beta-lactam. I would also let his fever run...as long as he is comfortable and able to rest.

Good luck, this sucks for you.

Here's a link regarding the Hib vaccine:

http://insidevaccines.com/wordpress/?page_id=24
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Old 04-24-2008, 11:52 PM
 
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Old 04-25-2008, 12:18 AM - Thread Starter
 
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I just found on this page that there are 6 strains, and that the vaccine covers only b strain. I know that the vax won't help for the current infection, but his immune system does not hold immunity well, so they'll pressure me to "supplement" his immune system with the vaccine (I know, I know, but he doesn't hold immunity, so what's the point in vaxing anyway??) I'm just telling you what they've been saying...

This is pulled from the link above:

"Nontypeable H influenzae form biofilm in vitro and ex vivo and has been implicated in chronic infection such as otitis media, sinusitis, and bronchitis. Nontypeable H influenzae biofilm formation was found in patients with CF on the apical surface of airway epithelia with decreased antibiotic susceptibility. Studies into the nature of this biofilm structure and proteins will help develop strategies to fight chronic infections. Persons at risk for invasive H influenzae disease include those with asplenia, sickle cell disease, complement deficiencies, Hodgkin disease, congenital or acquired hypogammaglobulinemia, and T-cell immunodeficiency states (eg, persons infected with human immunodeficiency virus [HIV])."

Connor's immune deficiency is low T-cell lymphocytes, so he falls into that at-risk category.

Here's what I found about beta-lactamase:

"Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting. Penicillins are useful in management of mucosal infections caused by nonencapsulated H influenzae. As many as 25-50% of isolates produce beta-lactamase; therefore, they are resistant to this class of drugs. Third-generation cephalosporins are highly effective in H influenzae infections. Meropenem or ampicillin and chloramphenicol are alternative regimens."

I understood this to mean that because his infection is beta-lactamase negative, that it should be susceptible to penicillins...am I reading that wrong?

I haven't read the links Gitti gave yet...

Mommy to BigBoy Ian (3-17-05) ; LittleBoy Connor (3-3-07) (DiGeorge/VCFS):; BabyBoy Gavin (10-3-09) x3 AngelBaby (1-7-06)
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Old 04-25-2008, 12:33 AM - Thread Starter
 
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Ah, attachedmama...that's what I was looking for, the links that show the increase of the other strains of Hi after introduction of the Hib vax. Thank you.

So I'm still firm in my decision not to give him that vax, and I'm armed with the info I need to defend that position (not that I *have* to defend it, even the infectious disease dr was not pushy about vaccines, he just "strongly suggested" them), but I'm still not understanding WHY we can't get rid of his current infection.

What's going on? The cultures responded to the abx in the lab, so something is going on in his immune system that's preventing him from kicking the infection... Grr.

Mommy to BigBoy Ian (3-17-05) ; LittleBoy Connor (3-3-07) (DiGeorge/VCFS):; BabyBoy Gavin (10-3-09) x3 AngelBaby (1-7-06)
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Old 04-25-2008, 12:35 AM
 
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Yes, plenty of serotypes out there. Betcha it's nontypable though. This has some interesting stuff about the bacteria in it. I think the links above should give you plenty of info about replacement effect.

As far as #4 goes, I would encourage you to post in H&H rather than here.


Quote:
Originally Posted by attachedmamaof3 View Post
Beta-lactamase negative is a description...basically what that means is that the bacteria (in his case H. influenzae) is resistant (or does not respond) to certian types of antibiotics. THAT would be the reason he's not responding.. they need to give him antibiotics that do not contain beta-lactam.
You might have another look at that.
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Old 04-25-2008, 12:43 AM
 
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It's the opposite. See in your quote:

Quote:
As many as 25-50% of isolates produce beta-lactamase; therefore, they are resistant to this class of drugs
Penicillins are commonly used (and work very well) for these types of infections EXCEPT in cases of beta lactamase negative.

The types of antibiotics that contain beta-lactam are:

penicillins

cephems- (consisting of cephalosporins and cephamycin) The names usually start with cef- there are 4 generations... for example: cefazplin, cefaclor,
cefoxitin, cefpodoxime

and carbapenems- these antibiotics' names usually end in -enem. for example: meropenem, ertapenem, doripenem

These are the ones you DON'T want to use. Which is why his infection hasn't been responding.
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Old 04-25-2008, 12:47 AM
 
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Quote:
Originally Posted by amnesiac View Post
You might have another look at that.
Uh oh, is that not right?? Do I have it backwards...dammit.

If the infection is beta-lactamase negative..doesn't that mean that OH CRAP~!

oh, I'VE got it completely turned around then eh? It's testing NEGATIVE for the enzyme not positive.

Okay, so the drugs I listed SHOULD be used.

Oh, I'm sorry!!!! sooo soo sorry!
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Old 04-25-2008, 12:51 AM - Thread Starter
 
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LOL! Tha's okay, it's confusing!!! I also had to look at it several times before I figured it out, then you posted your read on it and it threw me for a loop again

They specifically tested abx susceptibility with his culture and said that cipro and all -cillins should work. Yet they're not. That's why I'm calling the infectious disease dr tomorrow morning for more guidance.

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Old 04-25-2008, 12:53 AM
 
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There is one SPECIFICALLY used (because it works really well) for haemophilus...I'm trying to find the name so you can see if you've tried that one or not...
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Old 04-25-2008, 01:00 AM
 
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Here's my layman's breakdown about the issue of giving Hib vaccine in this case. Because of the very high rates of vaccination in the US since the introduction of HiB vaccine, there is very little Hi strain B going around now. Infections are now being caused by HiA or, most commonly, Hi "untypeable" (a few pps have mentioned this already). So, your LO is down with an Hi infection, most likely caused by untypeable Hi (I really would assume this unless you have definitive serological proof that it's B - as I said, B infections are way, way down thanks to the vaccine). The doctor therefore wants to vaccinate him against B, presumably because he's immunocompromised and the doc wants to make sure all your LO's bases are covered. That's great, except HiB isn't what he should really be worried about, since HiB isn't causing the bulk of invasive Hi disease anymore.

Hugs and good luck to you and your son. I hope he's feeling better soon!
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Old 04-25-2008, 01:02 AM
 
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Okay, there are three?? but they're listed as moderate spectrum..

but specifically anti-haemophilus:

cefaclor
cefuroxime
cefamandole

Levaquin is the brand name of a supposedly anti-haemophilus drug...but is for adults so..no help there maybe?

You may want to print this out and take a look at it. VERY interesting.

It's a study that shows that there have been findings of beta-lactamase negative strains that ARE resistant to ampicillin.

http://www.pubmedcentral.nih.gov/art...i?artid=153885

Quote:
Among the strains, 44.5% were TEM-type beta-lactamase producers and nine (1.3%) were beta-lactamase-negative ampicillin-resistant strains
Now, this is a VERY small percentage/number of children...but it is possible and may be something the immunologists at the hospital can look at and see if it's applicable in your son's case.
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Old 04-25-2008, 09:00 AM - Thread Starter
 
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Quote:
Originally Posted by attachedmamaof3 View Post
Okay, there are three?? but they're listed as moderate spectrum..

but specifically anti-haemophilus:

cefaclor
cefuroxime
cefamandole

Levaquin is the brand name of a supposedly anti-haemophilus drug...but is for adults so..no help there maybe?

You may want to print this out and take a look at it. VERY interesting.

It's a study that shows that there have been findings of beta-lactamase negative strains that ARE resistant to ampicillin.

http://www.pubmedcentral.nih.gov/art...i?artid=153885



Now, this is a VERY small percentage/number of children...but it is possible and may be something the immunologists at the hospital can look at and see if it's applicable in your son's case.
Thank you, I will look into this. But the nurse told me that his infection was susceptible to the "regular" abx...I took it to mean that they exposed HIS cultured infection the several abx and in lab conditions the abx killed it off. But I guess she could have been talking in generalities (as in, most infections of this type are susceptible to those abx) I'll have to ask more specifically.

Thank you all!!

And ktbug, that's exactly what the dr was saying about why he wants my son vaxed with Hib, because he's at high risk of complications from an invasive infection due to his immune deficiency and other medical conditions. But the low rate of circulation of that strain is one of the reasons why I declined the vax, serum replacement was another, and I believe that there's casein in that vax also? Can't remember now if that was one with it or not, I looked up the ingredients to all the vaxes a long time ago. Connor is very sensitive to milk and soy proteins.

Mommy to BigBoy Ian (3-17-05) ; LittleBoy Connor (3-3-07) (DiGeorge/VCFS):; BabyBoy Gavin (10-3-09) x3 AngelBaby (1-7-06)
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