| pasteurella multocida is the commonest cause of local infection after an animal bite, but is an unusual cause of meningitis. We report a case of P. multocida meningitis occurring in a 7-week-old infant which was contracted after non-traumatic contact with a household pet, that is, without any animal bite or scratch. The organism may be easily confused with more common Gram-negative pathogens. In this case, it was initially incorrectly diagnosed as haemophilus influenzae type b (Hib); a possibility which has important implications in the era of routine use of Hib vaccine in infant immunisation programs. CONCLUSION: pasteurella multocida is an unusual, but serious cause of meningitis in infancy. It is potentially preventable by the avoidance of contact between young infants and the saliva of household pets, in particular by assiduous hand hygiene. ( info) |
2/151. An adult with haemophilus meningitis: case report. An adult woman was found to have acute pyogenic meningitis caused by Haemophilus influenzae. Recent reports questioning the rarity of this form of adult meningitis are briefly reviewed. ( info) |
3/151. meningitis due to an unusual type of Haemophilus influenzae. An infant was admitted to hospital with suspected meningitis. Haemophilus influenzae type 'a' was isolated from cerebrospinal fluid (C.S.F.) and blood. Haemophilus meningitis due to types other than type 'b' is rare, and only a few due to type 'a' have so far been recorded. Investigations of the family are included together with a discussion of the implications for the diagnostic bacteriologist. ( info) |
4/151. Neonatal meningitis and mastoiditis caused by Hemophilus influenzae. A newborn infant developed Hemophilus influenzae meningitis associated with acute coalescent mastoiditis and a cutaneous abscess in the mastoid region. Mastoidectomy was followed by prompt recovery from the meningitis, which had failed to clear previously despite antibiotic therapy. mastoiditis may exist as an infective focus in neonatal meningitis more frequently than has been appreciated. Mastoid roentgenograms are usually the only clue to diagnosis of this infection and should be obtained in patients with neonatal meningitis responding poorly to antibiotic therapy. ( info) |
5/151. vaccination responses to capsular polysaccharides of neisseria meningitidis and haemophilus influenzae type b in two C2-deficient sisters: alternative pathway-mediated bacterial killing and evidence for a novel type of blocking IgG. meningitis caused by neisseria meningitidis serogroup W-135 was diagnosed in a 14-year-old girl with a history of neonatal septicemia and meningitis caused by group B streptococci type III. C2 deficiency type I was found in the patient and her healthy sister. Both sisters were vaccinated with tetravalent meningococcal vaccine and a conjugate haemophilus influenzae type b vaccine. Three main points emerged from the analysis. First, vaccination resulted in serum bactericidal responses demonstrating anticapsular antibody-mediated recruitment of the alternative pathway. Second, addition of C2 to prevaccination sera produced bactericidal activity in the absence of anticapsular antibodies, which suggested that the bactericidal action of antibodies to subcapsular antigens detected in the sera might strictly depend on the classical pathway. A third point concerned a previously unrecognized type of blocking activity. Thus, postvaccination sera of the healthy sister contained IgG that inhibited killing of serogroup W-135 in C2-deficient serum, and the deposition of C3 on enzyme-linked immunosorbent assay plates coated with purified W-135 polysaccharide. Our findings suggested blocking to be serogroup-specific and dependent on early classical pathway components. Retained opsonic activity probably supported post-vaccination immunity despite blocking of the bactericidal activity. The demonstration of functional vaccination responses with recruitment of alternative pathway-mediated defense should encourage further trial of capsular vaccines in classical pathway deficiency states. ( info) |
6/151. Relapse of Hemophilus influenzae type b meningitis after combined antibiotic therapy: report of a case. Antibiotic therapy of bacterial meningitis is being reevaluated due to reports of ampicillin-resistant strains of Hemophilus influenzae type b. The infant reported had a relapse of H. influenzae type b meningitis after an excellent clinical and bacteriologic response to an initial course of combined antibiotic therapy including chloramphenicol. This relapse is postulated to be due to localized cerebral vasculitis which was not treated for a sufficient period of time during the initial course of therapy. The patient responded well to a second course of penicillin and chloramphenicol. Since the use of pencillin and chloramphenicol will be increasing, the clinician should be aware that bacteriologic relapse of H. influenzae type b meningitis may occur with chloramphenicol therapy. ( info) |
7/151. Haemophilus influenzae meningitis: an evolving therapeutic regimen. ampicillin sodium has been the drug of choice in the treatment of Haemophilus influenzae meningitis. The development of ampicillin-resistant strains forces the clinician to focus on alternative therapies. We describe two patients in whom neutropenia was noted secondary to chloramphenicol administration, and streptomycin sulfate and sulfonamides were employed. An historical perspective summarizing the evolution of available therapeutic regimens is presented. ( info) |
| sepsis is often associated with a downward spiral through a spectrum of systemic inflammatory response syndrome (SIRS) culminating in organ failure and death. Here we present a 3-year-old girl with Hemophilus influenzae septic meningitis who developed SIRS and acute renal failure. In the initial stage, the patient showed uremia, cytopenia, disseminated intravascular coagulation, elevation of tissue enzyme and ferritin values, hemophagocytosis and overproduction of nitric oxide. The serum cytokine profile revealed increased levels of soluble interleukin (IL)-2 receptor, IL-6, IL-10 and tumor necrosis factor alpha. The patient responded positively to early and intensive interventions including antibiotics, repeated exchange transfusions, dexamethasone and high-dose gamma-globulin. The above laboratory abnormalities almost normalized with clinical improvement. We consider that SIRS was probably responsible for the sequence of events resulting in renal failure in this case, and suggest that renal failure should be included among the serious complications of SIRS associated with Hemophilus influenzae septic meningitis. ( info) |
9/151. Clonal spread of an invasive strain of haemophilus influenzae type b among nursery contacts accompanied by a high carriage rate of non-disease-associated strains. Haemophilus influenza carriage was examined in unvaccinated nursery contacts of a patient with H. influenzae type b (Hib) meningitis and isolates were typed by pulsed-field gel electrophoresis (PFGE). Nasopharyngeal isolates were classified into eight PFGE patterns. Seven Hib carriers were found among 15 nursery contacts. The isolates from the carriers showed a PFGE pattern identical to that of the meningitis strain. The carrier rate of non-disease-associated strains was also high (47%, 7 of 15). This study suggests that the clonal spread of invasive (serotype b) H. influenzae strains is accompanied by a high carriage rate of non-disease-associated strains. ( info) |
10/151. Intramuscular ceftriaxone in the treatment of childhood meningitis due to Haemophilus influenzae type F. OBJECTIVE: To describe a case of meningitis caused by Haemophilus influenzae type f (Hif) in a child. CASE SUMMARY: A 2.5-year-old white girl (18 kg) was hospitalized because of acute ataxia. The cerebrospinal fluid culture grew H. influenzae, which was later identified as type f. Therapy was limited by the inability to gain intravenous access. Treatment was initiated with dexamethasone 8 mg (0.44 mg/kg) intramuscularly, one dose on the day prior to initiation of ceftriaxone therapy, and intramuscular ceftriaxone 2 g (111 mg/kg/dose) once a day. After the first day, dexamethasone was administered at 3 mg (0.17 mg/kg/d) orally four times per day for four days. Within two days, the patient became afebrile and improved significantly. The remaining treatments were given during daily hospital visits on an outpatient basis. No complications occurred during the follow-up visits. DISCUSSION: The clinical presentation and therapeutic management of Hif meningitis is similar to that of H. influenzae type b (Hib) meningitis. Factors that may predispose a child to infections caused by Hif include upper respiratory tract infections, day care attendance, down syndrome, and immunodeficiency. Hif meningitis usually is treated with a third-generation cephalosporin (frequently ceftriaxone). Although most often administered intravenously, intramuscular ceftriaxone can provide a satisfactory clinical outcome in a child with adequate peripheral perfusion but limited intravenous access. The majority of reported cases of Hif meningitis resolve with appropriate antibiotic therapy; however, long-term neurologic sequelae occasionally occur. CONCLUSIONS: Hif occasionally causes pediatric meningitis. In a patient with good perfusion and difficult intravenous access, daily intramuscular administration of ceftriaxone can be an effective treatment option. In this case, Hif meningitis occurred abruptly and resolved within 48 hours of initiation of ceftriaxone and dexamethasone without long-term sequelae. The risks of giving dexamethasone appear to be minimal, although efficacy for preventing Hif complications remains to be proven. ( info) |