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Haemophilus influenzae meningitis with prolonged hospital course
L D Martin1, A M Kaplan, M F Rudinsky
1Division of Pediatrics, Phoenix Children's Hospital, Arizona 85006.
Abstract:
A retrospective evaluation of Haemophilus influenzae type b meningitis observed over a 2-year period documented 86 cases. Eight of these patients demonstrated an unusual clinical course characterized by persistent fever (duration: greater than 10 days), cerebrospinal fluid pleocytosis, profound meningeal enhancement on computed tomography, significant morbidity, and a prolonged hospital course. The mean age of these 8 patients was 6 months, in contrast to a mean age of 14 months for the entire group. Two patients had clinical evidence of relapse. Four of the 8 patients tested for latex particle agglutination in the cerebrospinal fluid remained positive after 10 days. All patients received antimicrobial therapy until they were afebrile for a minimum of 5 days. Subsequent neurologic examination revealed a persistent seizure disorder in 5 patients (62.5%), moderate-to-profound hearing loss in 2 (25%), mild ataxia in 1 (12.5%), and developmental delay with hydrocephalus which required shunting in 1 (12.5%). One patient had no sequelae.
Insights
This study identified a subset of Haemophilus influenzae type b meningitis cases with prolonged illness and severe neurological complications. Early identification and treatment are crucial for better outcomes in pediatric meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Haemophilus influenzae type b (Hib) meningitis is a serious infection in children.
- While treatable, some cases present with prolonged and severe clinical courses.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of Hib meningitis cases with an unusual, prolonged clinical course.
- To identify risk factors and sequelae associated with severe Hib meningitis.
Main Methods:
- Retrospective analysis of 86 Haemophilus influenzae type b meningitis cases over two years.
- Detailed review of clinical data, neuroimaging (CT scans), and laboratory results for a subset of 8 patients with prolonged illness.
Main Results:
- Eight patients (9.3%) had an unusual course: persistent fever (>10 days), pleocytosis, meningeal enhancement on CT, and prolonged hospitalization.
- These patients were younger (mean age 6 months) and experienced significant neurological sequelae, including seizures (62.5%) and hearing loss (25%).
- Two patients showed clinical relapse, and four had persistent positive latex agglutination tests in CSF after 10 days.
Conclusions:
- A distinct subgroup of Hib meningitis patients experiences prolonged illness and severe neurological deficits.
- Younger age and specific clinical/imaging findings may indicate a more severe disease course.
- Aggressive management and long-term follow-up are essential for children with severe Hib meningitis.