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[Haemophilus influenzae type B meningitis: typical and atypical presentation]
J M Sánchez1, F J Zurro, D Ferreiro
1Sección de Neurologiá, Hospital de San Agustín, Avilés, Asturias.
Abstract:
We present 2 cases of Haemophilus influenzae meningitis. The first is a patient with atypical simptomatology: abdominal pain, fever and two days later pain in the back of his legs. Abdominal pathology was not found. The cerebrospinal fluid (CSF) showed polymorphonuclear cells, hyperproteinorachia and lowered glucose. CSF culture revealed Haemophilus influenzae, blood culture was sterile. The second had suffered surgery at maxilar and ethmoid sinuses four years before, and unknown germ meningitis 6 months before. Haemophilus influenzae was isolated from CSF cultures and CSF rhinorrhea was detected by isotopic cisternography.
Insights
Two cases of Haemophilus influenzae meningitis highlight varied presentations. One patient showed atypical symptoms like abdominal pain, while the second had a history of sinus surgery and CSF rhinorrhea, underscoring the diverse clinical spectrum of this infection.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Haemophilus influenzae is a significant cause of bacterial meningitis, particularly in unvaccinated populations.
- Meningitis can present with diverse clinical manifestations, sometimes mimicking other conditions.
Observation:
- A patient presented with atypical symptoms including abdominal pain and leg pain, later diagnosed with Haemophilus influenzae meningitis.
- A second patient with a history of sinus surgery and prior meningitis experienced recurrent Haemophilus influenzae meningitis with cerebrospinal fluid (CSF) rhinorrhea.
Findings:
- Cerebrospinal fluid analysis revealed pleocytosis, elevated protein, and low glucose in the first case.
- Haemophilus influenzae was identified in CSF cultures for both patients; blood cultures were sterile in the first case.
- Isotopic cisternography confirmed CSF rhinorrhea in the second patient.
Implications:
- These cases emphasize the importance of considering Haemophilus influenzae meningitis even with unusual symptoms.
- Recognizing CSF rhinorrhea as a potential sign is crucial for diagnosing and managing recurrent meningitis.
- Early and accurate diagnosis of Haemophilus influenzae meningitis is vital for appropriate treatment and improved patient outcomes.