Haemophilus influenzae type b brain abscess complicating meningitis: case report

Area of Science:

• Pediatrics
• Infectious Diseases
• Neurology

Background:

• Haemophilus influenzae type b (Hib) meningitis is a serious infection in children.
• Early and appropriate antibiotic treatment is crucial for managing Hib meningitis.
• Complications, though rare, can arise even with effective initial treatment.

Observation:

• A 7-month-old infant diagnosed with beta-lactamase negative Hib meningitis received initial treatment with ampicillin and chloramphenicol.
• Following initial recovery and discharge, the child was readmitted with suspected meningitis relapse, but cultures were negative.
• On a third admission, a large frontoparietal brain abscess was identified, yielding beta-lactamase negative Hib.

Findings:

• The brain abscess, a rare complication, was successfully treated with needle aspiration and a 4-week course of ampicillin and chloramphenicol.
• Cultures from cerebrospinal fluid and blood did not yield growth during the relapse and abscess phases.
• The causative agent for the abscess was identified as beta-lactamase negative Haemophilus influenzae type b.

Implications:

• This case highlights the possibility of rare, late-onset complications like brain abscesses following seemingly resolved Hib meningitis.
• It underscores the importance of vigilant monitoring for neurological signs even after initial treatment success.
• The findings suggest that brain necrosis from initial meningitis may predispose to focal infections like abscess formation.