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Fulminating Haemophilus Influenzae b Meningitis

Published online by Cambridge University Press:  18 September 2015

N.E. MacDonald ,
D.L. Keene ,
A.M.R. Mackenzie ,
P. Humphreys ,
A.L. Jefferies  and
L.P. Ivan
N.E. MacDonald
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
D.L. Keene
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
A.M.R. Mackenzie
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
P. Humphreys
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
A.L. Jefferies
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
L.P. Ivan
Affiliation:
Departments of Pediatrics and Surgery (Neurosurgery), Children’s Hospital of Eastern Ontario, Ottawa, Ontario
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Haemophilus influenzae type b (HIb) is the most common cause of bacterial meningitis in children with a mortality rate ranging from 1.6% to 14%. Most patients have a 2-3 day history of symptoms prior to admission. A few have fulminating disease with rapid neurological deterioration. Review of 191 cases of HIb meningitis revealed a mortality rate of 2.1% but all who died had fulminating meningitis (FM). Four of six patients with FM died. FM patients had symptoms for less than 24 hours before rapid neurological deterioration with increased ICP, seizures, coma and/or respiratory arrest. Review of 10 FM cases revealed that on admission, 5 had hypotension, 3 had thrombocytopenia, and 8 had coma. Typical CSF changes were seen in only 7. All fatal cases died within 24 hours. Brain swelling and tonsillar herniation were found at autopsy. SDS-PAGE outer membrane protein subtyping did not show one “killer strain”. Animal and autopsy data suggest that diminished CSF outflow and cerebral edema contribute to increased ICP. To improve survival of FM patients, initial treatment must (1) decrease ICP below levels impairing cerebral perfusion, (2) maintain adequate ventilation and blood pressure, and include (3) LP when stable, (4) antibiotics, and (5) close monitoring. Utilizing these principles, two FM patients survived without major sequelae.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue 1 , February 1984 , pp. 78 - 81
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

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