Beta-lactamase-negative ampicillin-resistant Haemophilus influenzae type b meningitis in partially immunized...

Haemophilus influenzae is a Gram-negative coccobacillus that can cause many different kinds of infection, ranging from mild ear infection to life-threatening diseases like epiglottitis and meningitis. Encapsulated type b Haemophilus influenzae was most commonly responsible for Haemophilus influenzae meningitis in children before introduction of Haemophilus influenzae conjugate vaccine. None or partially immunized children are acquiring meningitis owing to resistant strains of Haemophilus influenzae, namely beta-lactamase-negative ampicillin-resistant strain.

We reported the case of a 2-year-old Emirati boy who presented to our emergency department with fever, diarrhea, vomiting, and fluctuating levels of consciousness. He was developmentally normal with no significant past medical history, except he was partially immunized. Earlier, he had been treated for acute gastroenteritis with intravenous fluids and antiemetics in another hospital and was discharged. His parents escorted him to our emergency department as he became very drowsy. Examination revealed that he was in septic shock. He was immediately treated with oxygen, intravenous antibiotics, and fluids after performing septic workup. He was then shifted to intensive care unit. Blood culture and cerebrospinal fluid Gram stain confirmed diagnosis of beta-lactamase-negative ampicillin-resistant Haemophilus influenzae. He was started on intravenous ceftriaxone, acyclovir, and dexamethasone. He still spiked fever after 1 week. Therefore, ceftriaxone was replaced by meropenem. He recovered well with no sequelae.

This case highlights atypical presentation of life-threatening illness along with microbial resistance that had positive outcome due to timely diagnosis and aggressive management by a multidisciplinary team.