haemophilus influenzae beta lactamase negative

[Luvscure1212]

I have what started out as what I thought was a hematoma on my face. I went to the ER, and was given clindamycin 150mg x12 a day. After 3 days, it was twice the size it was before, and very painful. I had an appointment with my doctor, and he took me off the clindamycin, and put me on penicillin. By that night, my jaw was 2 times the size it was that morning. I went to ER, and was told it was an abcess. They admitted me, and gave me iv antibiotics. My jaw kept getting bigger until the ENT came and did a I&D, which provided much needed relief. I stayed overnight in the hospital for more antibiotics. While there, my blood pressure wouldn't rise above 66/46 I think it hit 89/64 once. I was released on doxycycline mononhydrate 100mg and Amox-Clav 875mg both x3 a day.

Once the packing was removed, I felt better, the swelling went down some. 2 days later, I feel the swelling coming back. I also found out the results.
Organism 1                   | HAEMOPHILUS PARAINFLUENZAE I
        GROWTH                    | 100%
        ID RESPONSES              | BETA-LACTAMASE NEGATIVE

I don't know if I should go back or maybe if it gets worse, before it gets better. Has anyone had this....in the face? Not only is the swelling coming back, but my face is getting hard under my skin. Which sounds like cellulitis.

[mkh9]

Well it is good that it is going down. It sounds like it is going away slowly. I don't know if it is a keloid. Those are usually hard aren't they? Does it feel like the old one you have? I guess I would follow up with the doctor the next time  and ask them if is it is a keloid forming if you can prevent them. Hopefully not since it is on the face. Also, to confirm if the infection is cleared up or how long to stay on the antibiotics. Sounds like you are heading in the right direction for now.
mkh9

[Luvscure1212]

The swelling is still there. It's getting smaller. I'm still on antibiotics, they think there's infection still present. It's getting better, I just hope that it doesn't keloid. Anyway to prevent that? I'm Black, and this is my check, could it be swelling? Or a, keloid forming? I have a keloid on a old surgical scar, and a Hickman scar. Both have reduced in appearance in the past few years. This is a tightness.

[mkh9]

Well, they will only do a blood culture if you have a fever. So, keep a watch on your temperture and the swelling and pain.
take care,
mkh9

[Luvscure1212]

Thank you. I hope that it goes down. I'm almost done with the antibiotics. I don't know if they will give me more, or if I should take more. I guess another blood culture is in order.

[mkh9]

Well, I am glad that so far you don't have a fever and no warmth on the spot. It may be swelling due to inflammation. You can try putting an ice pack on it and see if the swelling goes down. Also, some Ibuprofen taken with food, if you can tolerate it. It is what they call a "clenched fist" wound. These can be very bad sometimes. This is because the mouth has a lot of bacteria in it. So keep a watchful eye like you are. Hopefully, the swelling will go down and it will get better. The results you showed are only what the initial report said so far. The antibiotics should take care of it as long as nothing else got in there. The gram stain or smear showed no organisms or other bacteria and no  pus cells so that is good. If the swab was taken right then from the initial picture it should clear up.
mkh9

[Luvscure1212]

Those results are from the areboric culture. Here's the full report, minus identify information.
Ordered:  ANAEROB W AERO
Comments: Type of Specimen: Surgical-Procedural
          SPECIMEN COMMENT: LEFT CHEEK I+D AT BEDSIDE
--------------------------------------------------------------------------------------------
  Procedure                         Result                         Verified           Site
--------------------------------------------------------------------------------------------
  GRAM STAIN  Final                                                04/25/15-1445      MH
        RESULT                    | FEW WBC'S SEEN
                                  | NO ORGANISMS SEEN
                                  |

  ANAEROBIC W AEROBIC CULTURE  Final                               04/27/15-1252      MH
        GROWTH                    | LIGHT GROWTH

     Organism 1                   | HAEMOPHILUS PARAINFLUENZAE I
        GROWTH                    | 100%
        ID RESPONSES              | BETA-LACTAMASE NEGATIVE

  ANAEROBIC W AEROBIC CULTURE  Preliminary (UPDATED)               04/26/15-1326      MH
        GROWTH                    | LIGHT GROWTH

     Organism 1                   | GRAM NEGATIVE ROD


I feel like cellulitis is forming and the underlying hardness is spreading. No fever, no warmth to the spot, just increasing swelling. I asked to see an infectious diseases specialist, but my doctor told me my culture was negative, and there was nothing there. I guess I'm seeing things. I bit someone...and they punched me, I guess they're blood and saliva got in a small cut my teeth made and that's how I got the infection in my cheek. Lesson learned.

[mkh9]

Hi and sorry you went through this. Usually Haemophilus parainfluenzae is a bacteria that is normal to have in your mouth. So somehow it got into a wound or cut in the mouth or open area and caused a wound that abscessed. Do you know if they did an anaerobic culture as well? This is to look at bacteria that grow without oxygen. These are also found in the mouth and wounds.The beta-lactamase negative means it is not resistant to penicillin types of antibiotics. So that is good news. Does it still hurt and do you have a fever now? Did they do a blood culture on you while you were in the ER?  So at this point can you get an appointment with an infectious disease doctor to have them follow up with you? Tell the front desk scheduler that you were in the ER and that you would like to follow up because your wound is starting to swell up again even though you are on antibiotics and see if you can get in soon. If you can't get in right away then try a family practice doctor. It may be okay and the swelling could be inflammation that it is healing but hard to know.  It would be best to have a qualified doctor look at it.Stay on the antibiotics until you see another doctor to confirm whether you are doing well or not. Obviously, if you spike a fever or get worse go back to the ER. But if you can get into a doctor soon then that would be good.
mkh9