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.

+DHPRSKLOXVFRORQL]DWLRQ

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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