Cerebral infarction in Hemophilus influenzae type B meningitis
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Abstract:
Over a 5-year period, 8 (4.7%) of the 170 children diagnosed at Milwaukee Children's Hospital as having Hemophilus influenzae type b (HITB) meningitis developed cerebral infarction. Compared with children who did not develop infarcts or with children who developed other neurologic complications, such as subdural effusion, empyema, or meningoencephalitis, these children had significantly higher cerebrospinal fluid (CSF) leukocyte counts on initial lumbar puncture and had a greater likelihood of seizure activity. In seven of eight patients with cerebral infarction, a focal or generalized seizure heralded neurologic findings associated with abnormal radiographic studies. Two of the eight patients died, and two were permanently severely damaged. In the other four patients, there was eventual recovery from gross neurologic deficits. The mortality in patients with HITB meningitis complicated by cerebral infarction (25%) was significantly greater than that in other patients with HITB meningitis (0.6%). The pathophysiology of infarction in patients with bacterial meningitis is uncertain but may in part relate to arteriospasm. Cerebral infarction is a serious, and in the present experience, not uncommon complication of H. influenzae meningitis.
Insights
Cerebral infarction is a serious complication of Hemophilus influenzae type b (HITB) meningitis in children. This study found HITB meningitis can lead to cerebral infarction, increasing mortality and severe neurological damage.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurocritical Care
Background:
- Bacterial meningitis, particularly Hemophilus influenzae type b (HITB), poses significant risks to children.
- Cerebral infarction is a recognized but not fully understood complication of pediatric meningitis.
- Understanding the incidence and outcomes of cerebral infarction in HITB meningitis is crucial for clinical management.
Purpose of the Study:
- To determine the incidence of cerebral infarction in children diagnosed with HITB meningitis.
- To identify clinical and laboratory factors associated with the development of cerebral infarction in this population.
- To evaluate the mortality and neurological outcomes in children with HITB meningitis complicated by cerebral infarction.
Main Methods:
- Retrospective analysis of 170 children diagnosed with HITB meningitis over a 5-year period.
- Comparison of clinical data, cerebrospinal fluid (CSF) analysis, and radiographic findings between children with and without cerebral infarction.
- Assessment of seizure activity, neurological deficits, and radiographic evidence in affected children.
Main Results:
- Cerebral infarction occurred in 4.7% (8 of 170) of children with HITB meningitis.
- Children who developed cerebral infarction had higher CSF leukocyte counts and a greater likelihood of seizures.
- Mortality was significantly higher (25%) in patients with HITB meningitis complicated by cerebral infarction compared to those without (0.6%).
Conclusions:
- Cerebral infarction is a serious and not uncommon complication of H. influenzae meningitis in children.
- Seizure activity and elevated CSF leukocyte counts are associated with cerebral infarction in HITB meningitis.
- Cerebral infarction significantly increases mortality and risk of severe neurological damage in pediatric patients with HITB meningitis.