|Year : 2012 | Volume
| Issue : 1 | Page : 32-33
Meningitis due to Hemophilus influenza
Manjula Vagarali, MB Kamat, SC Metgud, SG Karadesai
Department of Microbiology, J.N. Medical College, Belgaum, Karnataka, India
|Date of Web Publication||21-May-2012|
Department of Microbiology, J.N. Medical College, Belgaum, Karnataka
Source of Support: None, Conflict of Interest: None
Despite the availability of potent newer antibiotics, the mortality rate due to acute bacterial meningitis remains significantly high in India and other developing countries; ranging from 16 - 32%. A 10-year-old female child presented to us with fever, vomiting, and convulsion. Signs of meningial irritation were present. Hemophilus influenzae was identified in the laboratory. The child showed improvement with ceftriaxone and amikacin, and thus, the patient recovered satisfactorily.
Keywords: Hemophilus, meningitis
|How to cite this article:|
Vagarali M, Kamat M B, Metgud S C, Karadesai S G. Meningitis due to Hemophilus influenza. J Sci Soc 2012;39:32-3
| Introduction|| |
Acute bacterial meningitis remains a major cause of mortality and long-term neurological sequelae the world over. Despite the availability of potent newer antibiotics, the mortality rate due to acute bacterial meningitis remains significantly high in India and other developing countries, ranging from 16 - 32%. , There is a need for a periodic review of bacterial meningitis worldwide. As the pathogens responsible for the infection vary with time, geography, and patient age,  a delay in diagnosis and initiation of antimicrobial therapy can result in a poor outcome of the disease.  As the clinical signs of meningitis cannot always be relied upon,  laboratory support is imperative, to achieve an early diagnosis.
| Case Report|| |
A 10-year-old female child presented to us with fever, cough for one month, vomiting, and convulsions for a duration of two days. Fever was of low grade and continuous, not associated with chills or rigors. The cough was initially dry, but later became productive. She also had projectile vomiting and convulsions, about three episodes within two hours, with each episode lasting for 15 minutes. On recovery the child was drowsy and not responding to oral commands. The child was treated at a local hospital with intravenous fluids and medications, and then later referred to the KLE hospital. There was no history of involuntary passage of stool or urine. Nor was there a history of similar illness in the family.
On examination the child was conscious and irritable. Signs of meningeal irritation like Kernig's sign and Brudzinski's sign were positive. The cranial nerve examination was normal.
The cerebrospinal fluid (CSF) sample was collected. The CSF analysis showed red blood cells (RBC), 60 cells / cumm, lymphocytes 90%, polymorphonuclear cells 10%, sugar 102 mg / dl, and protein 36 mg / dl. Gram staining showed small, gram-negative coccobacilli. Then it was inoculated on to chocolate agar, incubated at 37°C, for 24 hours, which showed small, grayish, translucent, smooth colonies. The organism was positive for satellitism. Hemophilus influenzae was identified by a positive oxidase and catalase tests. Fermentation of glucose and xylose, and no fermentation of sucrose, lactose, and mannose was seen. The strain showed sensitivity to ceftriaxone and amikacin, and resistance to ampicillin, by Kirby-Bauer disk diffusion method. Amikacin and ceftriaxone were started with clinical improvement of the patient, and the patient recovered satisfactorily.
| Discussion|| |
Acute bacterial meningitis is a medical emergency, which warrants early diagnosis and aggressive therapy. Most often therapy for bacterial meningitis has to be initiated before the etiology is known. The choice of initial antimicrobial therapy in community-acquired acute bacterial meningitis is based on the most common pathogen prevalent in a particular geographical area and age group and the antibiotic sensitivity pattern.  Some Indian authors have reported a high incidence of Hemophilus influenzae meningitis in the pediatric age group.  This is similar to our case. The usual pathogens causing meningitis in infants and neonates are highly sensitive to ceftriaxone, which penetrates into the CSF, at levels 100 times the minimum inhibitory concentration (MIC) of these bacteria. Ceftriaxone therapy compares favorably with the standard therapy for patients with bacterial meningitis. , Our patient also showed clinical improvement with ceftriaxone therapy.
| References|| |
|1.||Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis: A ten -year retrospective study in a tertiary neurocare centre in South India. Indian J Med Microbiol 2007;25:108-14. |
|2.||Kabra SK, Kumar P, Verma IC, Mukherjee D, Chowdhary BH, Sengupta S, et al. Bacterial meningitis in India, an IJP survey. Indian J Pediatr 1991;58:505-11. |
|3.||Tang LM, Chen ST, Hsu WC, Lyu RK. Acute bacterial meningitis in adults: A hospital-based epidemiological study. QJM 1999;92:719-25. |
|4.||Celal A, Faruk GM, Salih H, Kemal CM, Serife A, Faruk KO. Characteristics of acute bacterial meningitis in Southeast Turkey. Indian J Med Sci 2004;58:327-33. |
|5.||Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A, et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr 2002;39:914-21. |
|6.||Van de Beek D, De Gans J, Tunkel AR, Wijdicks EF. Community- acquired bacterial meningitis in adults. N Engl J Med 2006;354:44-53. |
|7.||Steele RW, Bradsher RW. Comparison of ceftriaxone with standard therapy for bacterial meningitis. J Pediatr 1983;103:138-41. |