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Updated: Aug 8, 2025
Assessing Respiratory Immune Responses to Haemophilus Influenzae
Published on: June 29, 2021
[Haemophilus influenzae type B (Hib) meningitis in older children: about a case]
Ines Trabelsi1, Mouadh Ben Ali1, Manel Ben Romdhane1
1Service de Médecine Infantile B, Hôpital d'Enfants « Béchir Hamza » de Tunis, Tunis, Tunisie.
Insights
Invasive Haemophilus influenzae type b (Hib) infection is rare but can cause severe encephalitis in unvaccinated children. Prompt treatment with cefotaxime led to a full recovery without sequelae.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Invasive Haemophilus influenzae type b (Hib) infections are now rare due to widespread vaccination.
- However, severe cases can still occur in unvaccinated individuals, particularly children.
Observation:
- A 9-year-old unvaccinated boy presented with seizures, fever, and impaired consciousness, indicative of encephalitis.
- Cerebrospinal fluid analysis confirmed Hib meningitis with significant pleocytosis and neutrophil predominance.
- MRI revealed extensive encephalitis affecting both supratentorial and infratentorial brain regions.
Findings:
- The patient was diagnosed with invasive Haemophilus influenzae type b infection causing severe encephalitis.
- Treatment with cefotaxime resulted in a favorable clinical outcome.
- The patient experienced a complete recovery with no neurosensory deficits after a 3-year follow-up.
Implications:
- This case highlights the importance of Hib vaccination, even in the current era of reduced incidence.
- Severe Hib infections necessitate investigation for underlying immunodeficiencies in unvaccinated patients.
- Early diagnosis and appropriate antibiotic treatment are crucial for managing Hib encephalitis and preventing long-term complications.
Abstract:
Since widespread vaccination, invasive Haemophilus influenzae type b (Hib) has become a rare infection. We here report the case of a 9-year-old boy admitted with seizures associated with fever and impaired general condition. First examination showed comatose child, Glasgow score 9/15, fever 38.2, deep tendon reflexes without frank meningeal syndrome. Laboratory tests showed polymorphonuclear neutrophils (PNN) with CRP 45.8. Cerebrospinal fluid (CSF) analysis revealed a cloudy appearance, pleiocytosis (6760 white blood cell count/ mm3) with neutrophil predominance (PNN = 90%, lymphocytes = 10%). Direct examination showed polymorphic bacilli, soluble antigen of Haemophilus influenzae type b, decreased glycorachy 0.04 mmol/L and hyper proteinorachie 4.097 g/L. MRI of the cerebellomedullary fissure revealed subtentorial and supratentorial encephalitis with bilateral parieto-occipital and cerebellar cortical and subcortical signal anomalies. The patient was treated with cefotaxime with favorable outcome. The patient had not been vaccinated against Hib in early childhood. After a 3-year follow-up, the patient was asymptomatic with no neurosensory sequelae. In subjects with severe Hib infection proof of vaccination or testing for underlying immunodeficiency are required.
