haemophilus meningitis
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Author:PranatharthiHaranChandrasekar,MBBS,MDChiefEditor:KarenLRoos,MDmore...
Updated:Dec13,2013
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Throughoutthemoderneraofbacteriology,+DHPRSKLOXVLQIOXHQ]DHtypeb(Hib)hasbeenidentifiedas1ofthe3mostcommoncausesofbacterialmeningitisinadolescents.Theother2are1HLVVHULDPHQLQJLWLGLVand6WUHSWRFRFFXVSQHXPRQLDH.Beforethedevelopmentofeffectiveimmunizations,these3bacteriaaccountedformorethan80%ofallcasesofmeningitisinindustrializednations.(SeePathophysiologyandEtiology.)
Initialmanifestationsofmeningitis,seeninmorethanhalfofallcasesofHibmeningitis,includealteredcry,change
inmentation,nauseaorvomiting,fever,headache,photophobia,meningismus,irritability,anorexia,andseizures.
ThepossibilityofHibmeningitisissuggestedbythepresenceofriskfactors(eg,timeofyear,patientage,
vaccinationstatus),aswellasclinicalfeatures.(SeeClinicalPresentationandDiagnosis.)
Lumbarpunctureiscriticalintheevaluationofpatientswithsuspectedmeningitisandshouldbeperformedunless
somespecificcontraindicationexists.Intheabsenceoffocalneurologicfindings,theriskofherniationincasesof
Hibmeningitisislowandonecansafelyproceedtolumbarpuncturewithoutimaging.Brainimagingisalsohelpfulin
certaincases.(SeeWorkup.)
Themostcriticalaspectofinitialtreatmentispromptinitiationofantimicrobialtherapy,becauseanydelayin
treatmentisassociatedwithincreasedmorbidityandmortality.Eithercefotaximeorceftriaxoneshouldbeinitially
providedtochildrenwhopresentwithmeningitisandwhoareolderthan6weeksandyoungerthan6years.
Adjunctiveantiinflammatorytherapycontinuestobecontroversial.(SeeTreatmentandManagement.)
IncountrieswhereeffectiveimmunizationagainstHibhasbeenprovidedtochildren,theincidenceofHibmeningitis
aswellasotherseriousHibrelateddiseases,suchaspneumoniaorsepsishasdiminishedbyasmuchas87
90%ormore.Unfortunately,theimportantgoalofglobalimmunizationofchildrenagainstHibhasnotyetbeen
realized.(SeePreventionofHaemophilusMeningitis.)
GotoMeningitis,MeningococcalMeningitis,StaphylococcalMeningitis,TuberculousMeningitis,ViralMeningitis,and
AsepticMeningitisformorecompleteinformationonthesetopics.
3DWKRSK\VLRORJ\
+DHPRSKLOXVspeciesaresmalloxidasepositivepleomorphicgramnegativeaerobicorfacultativeanaerobiccoccobacilli.Humansaretheonlyknownhostfor+DHPRSKLOXVLQIOXHQ]DH.
+DHPRSKLOXVstrainsmaybeencapsulatedorunencapsulated.Encapsulatedstrains(alsoknownastypeable)aresurroundedbyapolysaccharidecapsulethatplaysanimportantroleinthedeterminationofvirulenceofthe
organism.Theoutermembranelipooligosaccharidesalsocontributetothedegreeofvirulence.Encapsulated
strainsaredivided,onthebasisofcapsularantigens,into6serotypesdesignatedDthroughI.Unencapsulatedstrainslackthepolysaccharidecapsuleandaredesignateduntypablestrains.
Transmissibilityof+LQIOXHQ]DHinfectionandthecapacityofthisorganismtocausepurulentmeningitiswerefirstdemonstratedbyWollsteinin1911.Shealsodrewattentiontothemarkedtendencyfor+DHPRSKLOXVmeningitistooccurininfantsandyoungchildren.In1931,Pittmandemonstratedthat+LQIOXHQ]DHtypeb(Hib)accountedforalmostallcasesofmeningitis.
Inanimportantseriesofstudiespublishedin1933,FothergillandWrightenlargedtheepidemiologicunderstanding
ofHibmeningitis,theprotectiveroleofpassivelytransmittedmaternalantibodies,andtheinadequacyofhost
immuneresponsefrominfancytoage3years.Theydemonstratedthatthismaternallyconferredprotectionlargely
dissipatesbyage4months.
Between46and60%ofallseriousHibrelateddiseasespresentasmeningitis.Hibsmedicalimportancehas
includedtherolethatithasplayedintheexperimentalandpathologicalstudyofinfectiousdiseasesinawidevariety
oforgansystems.Thebacteriumhasprovidedparticularlyvaluableinformationconcerningtheunderstandingofthe
pathophysiologyofmeningitis.
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Tobecomeinfectedwith+DHPRSKLOXV,individualsmustfirstacquireastateofnasopharyngealcolonization,afairlycommoneventofearlylife.Acquisitionof+DHPRSKLOXVprobablyoccursbyinhalationofaerosolizedrespiratorydroplets,althoughnosefingerfingernoseroutesmayplayaroleinpersontopersontransmission.
+DHPRSKLOXVcolonizationoccursmostlywithunencapsulatedstrainsencapsulatedstrainsareonlyrarelydetected.InNorthAmerica,25%ofyoungchildrenarecolonizedwithHib,themostimportantcauseof+DHPRSKLOXVinfections.Hibcolonizationismuchlessfrequentlyfoundinadultsandinchildrenyoungerthan1year.
Ratesofcarriageareevenlowerinimmunizedpopulations.However,ratesofcarriagearemuchhigheramong
householdcontactsofanindexcase.Twentyto25%ofallthoseexposedtotheindexcasebecomecolonized.
Amongchildrenyoungerthan6yearswhoareexposed,carriageratesareashighas50%.Interestingly,therateof
nasopharyngealcolonizationislowerinhouseholdcontactsofachildwithHibepiglottitisthanthoseofachildwith
Hibmeningitis.
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3/22/2015 Haemophilus Meningitis
http://emedicine.medscape.com/article/1164916-overview 3/8
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