Management of recurrent invasive Haemophilus influenzae infection

A 4 1/2-month-old infant had three separate episodes of invasive Haemophilus influenzae type b infection and did not produce antibody to the capsular polysaccharide of H influenzae b. Immunologic evaluation disclosed normal immunoglobulin and complement concentrations and normal T-cell number and function. In view of the persistent presence of type-specific capsular polysaccharide of H influenzae b (polyribophosphate [PRP]) in blood serum without any detectable anti-PRP antibody for 30 days following H influenzae b meningitis, monthly treatment with immune human serum globulin was undertaken until spontaneous production of anti-PRP antibody occurred. The patient's 4-year-old sibling was found to be a nasopharyngeal carrier and may have been a source for reinfection. A search for possible family carriers should be conducted in evaluating the conditions of patients with recurrent invasive H influenzae b infection. In addition, temporary treatment with immune human serum globulin should be considered.