From a high proportion of children sent to hospital H. influenzae can be isolated if suitable culture media are used. A number of H. influenzae strains were isolated from unusual sites, such as (1) blood cultures after tonsillectomy or tonsillotomy in five cases; (2) urine or the urinary tract in eight cases; (3) the lumen of appendices removed at operation in 11 cases (4%); (4) osteomyelitis or pyarthrosis in six cases; (5) miscellaneous infections including two perianal abscesses, three cases of paronychia, one infected thyroglossal cyst, and several skin infections.
It is suggested that infections of the skeletal system and the urinary tract arise from haematogenous spread of H. influenzae, as demonstrated by positive blood cultures after tonsillectomy and in two cases of skeletal infection. Infection of the appendix, perianal abscesses, paronychia, and skin infections probably arise by the direct route, either by immediate contact or by passage of viable organisms through the alimentary canal.
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