title: Haemophilus influenzae Sepsis and Placental Abruption in an Unvaccinated Immigrant.
abstract: BACKGROUND
  Haemophilus influenzae infections have declined dramatically in the United States since implementation of the conjugate vaccine. However, in countries where widespread immunization is not routine, H influenzae remains a significant cause of morbidity and mortality. We report a case of a previously unvaccinated immigrant with confirmed H influenzae sepsis and placental abruption leading to spontaneous abortion.
  
  
  OBJECTIVE
  To alert emergency medicine practitioners that H influenzae should be recognized as a maternal, fetal, and neonatal pathogen. Clinicians should consider this diagnosis in immigrants presenting with uncertain vaccination history, as H influenzae can cause significant morbidity and mortality.
  
  
  METHODS
  A 36-year-old female was referred to our emergency department (ED) with lower abdominal pain with some vaginal spotting. The patient had an initial visit with normal laboratory investigations and normal imaging results, with complete resolution of symptoms. The patient returned to the ED with sudden onset of vaginal bleeding and abdominal pain. She presented at this time with sepsis, which progressed to septic shock, causing placental abruption and ultimately, spontaneous abortion. The patient was treated with pressors and antibiotics and was admitted to the medical intensive care unit where she received ampicillin, gentamycin, and clindamycin for suspected chorioamnionitis. The patient's blood cultures came back positive after 1 day for H influenzae. The patient did well and was discharged from the hospital 4 days later.
  
  
  CONCLUSIONS
  Haemophilus influenzae should be recognized as a neonatal and maternal pathogen. Clinicians should consider this diagnosis in immigrants presenting with uncertain vaccination history, especially in pregnant females, as H influenzae can cause significant morbidity and mortality.
authors.affiliation: Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Calner
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salinas
authors.forename: Alaina
authors.initials: A
authors.lastname: Steck
authors.forename: Elissa
authors.initials: E
authors.lastname: Schechter-Perkins