Community-acquired haemophilus influenzae meningitis in adults – brouwer – 2007 – clinical microbiology and infection – wiley online library

Haemophilus influenzae is an uncommon cause of bacterial meningitis in adults. Symptoms of meningitis in kids This report describes a prospective evaluation of 16 episodes of community-acquired H. influenzae meningitis in a nationwide study on bacterial meningitis. Meningitis a and c vaccine Predisposing conditions were present in eight (50%) of the 16 episodes; the most common predisposing conditions were otitis or sinusitis (five episodes; 31%) and remote neurosurgery or head trauma (three episodes; 19%). Meningitis q es One (6%) episode was fatal and hearing loss occurred in four (25%) episodes.


Viral meningitis causes It was concluded that H. influenzae meningitis in adults is a disease with a rather benign clinical course and a relatively good prognosis compared with pneumococcal meningitis.
Haemophilus influenzae meningitis occurs sporadically in adults and has been described in small retrospective case series as a disease following remote head trauma or neurosurgery, or in patients with predisposing conditions [ 1–5]. B meningitis A recent report described a prospective nationwide cohort study in The Netherlands that involved 696 adults with community-acquired bacterial meningitis [ 6]. Meningitis rash start The present report describes the clinical features, complications and outcome for adults in the cohort with H. influenzae meningitis.
The methods used have been described previously [ 6]. What does meningitis look like on a baby In brief, eligible patients were aged >16 years, had bacterial meningitis confirmed by culture of cerebrospinal fluid (CSF), and were listed in the database of The Netherlands Reference Laboratory for Bacterial Meningitis between October 1998 and April 2002. Cure for viral meningitis The treating physician was contacted and informed consent was obtained from participating patients or their legal representatives. Meningitis in toddlers The study was also approved by the local ethics committee. Meningitis vaccine cost Patients with hospital-acquired meningitis (defined as meningitis that occurred during hospitalisation or within 1 week of discharge), neurosurgical devices and/or a history of recent (within 1 month) head trauma or neurosurgery were excluded. Meningite in english Patients with an altered immune status caused by use of immunosuppressive drugs, splenectomy, diabetes mellitus or alcoholism were considered to be immunocompromised. Meningite in toscana 2016 Predisposing factors for developing bacterial meningitis were defined as otitis, sinusitis, pneumonia, an immunocompromised state, remote neurosurgery and remote head trauma (occurring ?1 month before the onset of meningitis). Meningitis exam Patients underwent a neurological examination at discharge, and outcome was graded with the Glasgow outcome scale. Meningitis septicaemia Complaints of hearing loss were confirmed by an audiogram examination. Meningite quadrivalente All patients with bacterial meningitis and CSF cultures positive for H. influenzae were included in this study.
In total, 16 episodes of community-acquired H. influenzae meningitis were identified in 15 patients ( Table 1). Meningitis vaccine recommendations The calculated annual incidence was 0.04 cases/100 000 adults. Meningitis vaccine reaction Predisposing conditions were present in eight (50%) of 16 episodes. Meningitis immunization The most common predisposing conditions were otitis or sinusitis (five episodes; 31%) and remote neurosurgery or head trauma (three episodes; 19%). Meningitis lp A previous episode of meningitis had occurred for three (19%) of the 16 episodes. Organisms causing meningitis The clinical severity upon presentation was relatively mild, with only one (6%) episode having a change in mental status (defined as a Glasgow Coma Score <14); none of the patients had focal cerebral deficits upon admission. Table 1. Haemophilus influenzae meningitis Clinical, laboratory and radiological characteristics upon admission for 16 episodes of community-acquired Haemophilus influenzae meningitis a Characteristic Continuous data are denoted as the median value (range) unless otherwise stated. CSF pressure was measured in three episodes; CSF white cell count was determined in 16 episodes; CSF protein concentration was determined in 13 episodes; CSF/serum glucose ratio was determined in 12 episodes. Post-operative defects; sinusitis; combination of a sub-arachnoid cyst and pneumatocephalus. Triad of fever, neck stiffness, and change in mental status, n (%) All patients underwent a lumbar puncture. What are symptoms of meningitis At least one individual CSF finding predictive of bacterial meningitis (glucose <1.9 mmol/L, CSF serum glucose ratio <0.23, protein concentration >2.20 g/L, white cell count >2000 cells/mm 3 or CSF neutrophil count >1180 cells/mm 3) [ 7] was observed in 15 (94%) of the 16 episodes. Meningitis from vaccine Complications developed in a relatively low proportion of patients ( Table 2). Spinal meningitis causes One (6%) patient died after developing hemiparesis, impaired consciousness and septic shock, but all other patients had a good recovery. Treatment of meningitis Hearing impairment was found at discharge in four (27%) of 15 episodes, and memory deficits were reported in one (7%) episode.
Table 2. Viral meningitis treatment adults Therapy, complications during admission and outcome of cases of adult Haemophilus influenzae meningitis Characteristic
Serotyping of H. influenzae was performed on 15 isolates and revealed one each of serotypes b, e and f, together with 12 non-typeable isolates. Spinal meningitis baby In one episode, the H. influenzae isolate was ?-lactamase-positive; this isolate was of type b and caused the only fatal case in this case series. Symptoms of meningitis vaccine All cases received adequate microbiological cover by the initial therapy administered. Meningitis b vaccine for 2 year olds Adjunctive steroids were given to one patient after clinical deterioration. Meningite maladie One patient was included in the European Dexamethasone Study and was randomised to the placebo group [ 8].
Overall, these findings indicate that H. influenzae meningitis in adults is a relatively benign disease, especially in comparison with pneumococcal meningitis [ 6]. Symptoms of bacterial meningitis Only one patient presented with a change in mental status, although previous reports have described impaired consciousness in a greater proportion (16–67%) of patients with H. influenzae meningitis [ 4,5,9]. Spinal meningitis symptoms child The benign character of this disease was also reflected in the low mortality rate (6%). Meningitis symptoms in dogs Predisposing factors were present in 50% of the episodes, which corresponds with a previous description of predisposing conditions in 55% of 119 adults with H. influenzae meningitis [ 4]. Meningitis test The high percentage of patients with anatomical defects and ear or sinus infections as an underlying cause of H. influenzae meningitis justifies consultation with an otolaryngologist for this patient group.
Most (80%) H. influenzae isolates in this series were non-typeable, which corresponds with epidemiological trends observed after the introduction of Hib vaccination [ 10–12]. Meningitis symptoms adults stiff neck The single serotype b strain was ?-lactamase-positive and caused sepsis and death, despite adequate antibiotic therapy. Bacterial meningitis adults The most important mechanism of antibiotic resistance in H. influenzae involves ?-lactamase production, and occurs in 4–31% of all H. influenzae isolates worldwide [ 13,14]. Meningitis viral infection Empirical therapy for H. influenzae should include a third-generation cephalosporin until susceptibility testing has been performed [ 2,14].
The most common sequela was hearing loss, at 25%. Meningitis death rate This is an exceptionally high rate and is much higher than that described for children with H. influenzae meningitis [ 15,16]. Meningitis vaccine administration A meta-analysis of children with H. influenzae meningitis found that adjunctive dexamethasone treatment was associated with a decline in the rate of hearing impairment [ 17]. Meningite contagio In adults with bacterial meningitis, adjunctive dexamethasone therapy has now been established clearly to be beneficial [ 2,8,18,19]. After meningitis Since this study was performed before routine use of dexamethasone in adults with bacterial meningitis, only one patient received treatment with dexamethasone, which was prompted by clinical deterioration.
This study has several limitations. Complications of meningitis First, only patients with a positive CSF culture were included [ 1,6]. Meningitis contagious However, the clinical presentation in patients with positive and negative CSF cultures was similar to that in previous studies [ 1,20]. Signs and symptoms of meningitis in babies In patients found to have space-occupying lesions following computed tomography scan, or with coagulation disorders or severe septic shock, lumbar puncture might not be performed or might be postponed, which can result in negative CSF cultures [ 6]. Acute meningitis rash Therefore, these patient groups were probably only partly represented in the study.
In conclusion, H. influenzae meningitis in adults is a disease with a rather benign clinical course and a relatively good prognosis, especially when compared with pneumococcal meningitis. Meningite meningococica transmissao Many adults with H. influenzae meningitis have predisposing conditions, and the need to consult an otolaryngologist concerning these patients is emphasised. Infant meningitis Acknowledgements
We are indebted to many physicians in The Netherlands for their cooperation. Prognosis of meningitis The Dutch Meningitis Cohort Study was supported, in part, by a research grant from Roche Pharmaceuticals. Meningite bebe JdG received a research grant from Baxter BV. Viral meningitis in babies DvdB received research grants from the Meningitis Research Foundation UK and the Meerwaldt Foundation, and is supported by personal grants from the Netherlands Organization for Health Research and Development (ZonMw): NWO-Veni grant 2006 (916.76.023), and NWO-Rubicon grant 2006 (019.2006.1.310.001). Common causes of meningitis Ancillary Article Information
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