Haemophilus influenzae meningitis in the presence of cerebrospinal fluid shunts
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S Stern1, R Bayston, R J Hayward
1Department of Neurosurgery, Hospital for Sick Children, London, UK.
Abstract:
Haemophilus influenzae is an uncommon pathogen in shunted patients and there is uncertainty about optimal management. We report here two cases which were managed differently, with different outcomes. The first case was treated with chloramphenicol and the shunt was not removed. Although there were subsequent episodes of respiratory infection, the outcome was satisfactory. The second case was treated with cefuroxime and the shunt was exteriorized. Re-shunting was followed by relapse and further shunt removal. This and other case reports suggest that in Haemophilus meningitis in shunted patients treatment need not involve shunt removal, but that this is so only if appropriate antimicrobials such as chloramphenicol are used.
Insights
Haemophilus influenzae meningitis in shunted patients can be treated effectively without shunt removal. Chloramphenicol use, unlike cefuroxime, was associated with satisfactory outcomes in these cases.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Pediatrics
Background:
- Haemophilus influenzae is a rare cause of infection in patients with shunts.
- Optimal management strategies for Haemophilus influenzae infections in shunted patients remain unclear.
Observation:
- Two cases of Haemophilus influenzae meningitis in shunted patients were managed differently.
- Case 1: Treated with chloramphenicol; shunt retained. Case 2: Treated with cefuroxime; shunt exteriorized.
Findings:
- Case 1 had a satisfactory outcome despite subsequent respiratory infections.
- Case 2 experienced relapse and further shunt removal after initial treatment and re-shunting.
Implications:
- Shunt removal may not be necessary for Haemophilus meningitis in shunted patients.
- Appropriate antimicrobial selection, such as chloramphenicol, is crucial for successful treatment and avoiding complications.