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Haemophilus influenzae type b brain abscess complicating meningitis: case report
Abstract:
A 7-month-old child developed beta-lactamase negative Haemophilus influenzae type b meningitis which was treated with parenteral ampicillin and chloramphenicol for two days and ampicillin for eight additional days. She was readmitted two days after discharge on the 14th day after the initial hospitalization because of a suspected relapse of meningitis. Cultures of CSF and blood yielded no growth, and therapy with ampicillin and chloramphenicol was discontinued after three days. After discharge, her fontanel became full and a large, right, frontoparietal brain abscess was found on her third admission on day 25. Pus from the abscess yielded beta-lactamase negative H influenzae type b but CSF and blood yielded no growth. The abscess resolved after needle aspiration of pus and 4 weeks of therapy with ampicillin and chloramphenicol. It is speculated that this rare complication of H influenzae meningitis arose from a focal infection in an area of brain necrosis that resulted from the initial meningitis.
Insights
A rare brain abscess complication occurred in a child with Haemophilus influenzae type b meningitis. Prompt treatment with antibiotics and abscess drainage led to recovery.
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.