Relapse of Hemophilus influenzae Type b Meningitis After Combined Antibiotic Therapy: Report of a Case

PEDIATRICS ◽  
1976 ◽  
Vol 57 (3) ◽  
pp. 387-391
Author(s):  
William E. Feldman ◽  
William E. Laupus ◽  
Pal Ledaal
Keyword(s):  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Cerebral Vasculitis ◽  
Type B ◽  
Hemophilus Influenzae ◽  
Resistant Strains ◽  
Hemophilus Influenzae Type B ◽  
Bacteriologic Response

Antibiotic therapy of bacterial meningitis is being reevaluated due to reports of ampicillin-resistant strains of Hemophilus influenzae type b. The infant reported had a relapse of H. influenzae type b meningitis after an excellent clinical and bacteriologic response to an initial course of combined antibiotic therapy including chloramphenicol. This relapse is postulated to be due to localized cerebral vasculitis which was not treated for a sufficient period of time during the initial course of therapy. The patient responded well to a second course of penicillin and chloramphenicol. Since the use of penicillin and chloramphenicol will be increasing, the clinician should be aware that bacteriologic relapse of H. influenzae type b meningitis may occur with chloramphenicol therapy.

Hemophilus influenzae type b infections: Recurrent disease due to ampicillin-resistant strains

1977 ◽  
Vol 90 (2) ◽  
pp. 319-320 ◽  
Author(s):  
Gilles Delage ◽  
Yves DeClerck ◽  
Joëlle Lescop ◽  
Pierre Déry ◽  
François Shareck
Keyword(s):  
Recurrent Disease ◽  
Type B ◽  
Hemophilus Influenzae ◽  
Resistant Strains ◽  
Hemophilus Influenzae Type B

Ampicillin-Resistant Strains of Hemophilus influenzae type B

PEDIATRICS ◽  
1975 ◽  
Vol 55 (1) ◽  
pp. 145-146
Author(s):  
Samuel Katz ◽  
Jerome O. Klein ◽  
Martha D. Yow ◽  
Fred F. Barrett ◽  
Roger S. Feldman ◽  
...  
Keyword(s):  
Disease Control ◽  
The United States ◽  
Penicillin G ◽  
Type B ◽  
In Vitro Susceptibility ◽  
Hemophilus Influenzae ◽  
Sensitivity Tests ◽  
Resistant Strains ◽  
Hemophilus Influenzae Type B

Strains of Hemophilus influenzae type b highly resistant in vitro to ampicillin have been reported from several widely separated locations in the United States since December 1973.1-4 These strains were isolated from children with meningitis and the clinical course corroborated the in vitro susceptibility results. Until the importance of these resistant strains can be ascertained, hospital laboratories are urged to test clinical isolates of H. influenzae type b for susceptibility to ampicillin, and physicians must reconsider the treatment of patients with severe disease due to this organism. Ampicillin disk sensitivity tests of H. influenzae isolates are satisfactory for screening purposes but strains that are of equivocal sensitivity or are resistant should also be tested by a quantitative method, such as the tube dilution or agar diffusion techniques. The appropriate methods for antibiotic susceptibility tests were reviewed recently in a weekly report of the Center for Disease control.5 If facilities for these tests are unavailable or if confirmation of test results is desired, the bacterial strains may be forwarded, via the State Public Health Laboratory, to the Center for Disease Control. In areas where resistant strains have been recognized, initial therapy of children with documented or suspected severe infection due to H. infiuenzae type b, such as sepsis, meningitis, epiglottitis, arthritis, or cellulitis, should include an antimicrobial agent of known efficacy. Initial administration of penicillin G or ampicillin and chloramphenicol would seem appropriate at this time. The antimicrobial regimen should be reevaluated when the results of the bacterial isolation studies and antimicrobial sensitivity tests are available.

The Retreat of Hemophilus Influenzae Type B Invasive Disease: Analysis of an Immunization Program and Implications for OTO-HNS

1993 ◽  
Vol 109 (4) ◽  
pp. 712-721 ◽  
Author(s):  
Richard A. Beck ◽  
Scott Kambiss ◽  
James W. Bass
Keyword(s):  
Bacterial Meningitis ◽  
The United States ◽  
Invasive Disease ◽  
Economic Modeling ◽  
Sample Population ◽  
Type B ◽  
Immunization Program ◽  
Hemophilus Influenzae ◽  
Hemophilus Influenzae Type B ◽  
The Impact

Hemophilus influenzae type b (Hib) is the most common cause of bacterial meningitis among children under 5 years old. Hib is also responsible for other invasive diseases including epiglottitis, cellulitis, sepsis, pneumonia, and osteomyelitis. A child's cumulative risk of systemic Hib disease during the first 5 years of life is approximately 1 in 200. A polysaccharide Hib vaccine was first marketed in 1985, and newer, more effective conjugated vaccines have been licensed since 1987. Immunization schedules have Included Increasingly younger children. No studies have been published that analyze the effects of a vigorous immunization program on a sample population representative of the United States at large. Records of pediatric patients ages 5 years and younger who were treated for Hib meningitis or epiglottitis ( N = 373) at all U.S. Army medical facilities between 1986 and 1991 were reviewed. The combined incidence of these diseases declined by more than 86% in the study group during this period. The largest decrease occurred in infants less than 1 year old, before vaccines were licensed for use in this group. Meanwhile, the number of cases of bacterial meningitis due to other organisms in this cohort remained unchanged. Economic modeling validates the cost-effectiveness of vaccination. The impact of these preliminary trends on health care systems and otolaryngology-head and neck surgery will be significant. Almost two thirds of Hib disease has involved infants under 15 months old, for whom a conjugated vaccine has been available only since October 1990. The change in disease frequency will have substantial bearing on training programs, because management of neurologic sequelae and the emergent airway require the expertise of otolaryngologists. In the face of medical onslaught, Hib invasive disease is in retreat

Current Status of Ampicillin-Resistant Hemophilus influenzae Type b

PEDIATRICS ◽  
1976 ◽  
Vol 57 (3) ◽  
pp. 417-417
Author(s):  
Samuel L. Katz ◽  
Ernesto Calderon ◽  
David H. Carver ◽  
Henry G. Cramblett ◽  
Thomas E. Frothingham ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Combined Therapy ◽  
Penicillin G ◽  
Current Status ◽  
Committee Report ◽  
Type B ◽  
Initial Management ◽  
Hemophilus Influenzae ◽  
Resistant Strains ◽  
Hemophilus Influenzae Type B

At its meeting on April 16, 1975, the Committee on Infectious Diseases reconsidered the problem of ampicillin-resistant strains of Hemophilus influenzae type b. The following facts were noted: (1) Strains of H. influenzae type b highly resistant in vitro to ampicillin have been reported from 20 states and the District of Columbia.1 (2) These strains were isolated from children with sepsis, meningitis, cellulitis, epiglottitis, suppurative arthritis, and pneumonia. Some of the children died when the resistance of the etiologic strain was not appreciated. (3) The prevalence of these strains is still uncertain but appears to be at a low level in most communities. Epidemiologic studies, however, indicate these strains may infect many children in closed communities, such as day-care centers.2 The Committee believes a modification of its prior statement3 is warranted based on the wide-spread occurrence of these strains: (1) Initial management of children with documented or suspected severe infection due to H. influenzae type b (including meningitis, epiglotitis and sepsis) should include a parenteral penicillin (penicillin G or ampicillin) and intravenous chioramphenicol. (2) All strains of H. influenzae type b should be tested for susceptibility to ampicillin as early as possible. (3) Ampicillin alone as initial therapy for children with severe infections that may be due to H. influenzae should be considered only in areas of the country where ampicillin-resistant strains of H. influenzae type b have not appeared and where active programs of bacterial surveillance and rapid laboratory diagnosis of susceptibility to antimicrobial agents are available. The dosage schedules, rationale for combined therapy as initial management, and description of susceptibility tests for H. influenzae are given in the initial Committee Report.3

Evaluation of a Rapid β-Lactamase Test for Detecting Ampicillin-Resistant Strains of Hemophilus influenzae Type b

PEDIATRICS ◽  
1976 ◽  
Vol 58 (3) ◽  
pp. 382-387
Author(s):  
David W. Scheifele ◽  
Vassiliki P. Syriopoulou ◽  
A. Lynn Harding ◽  
Barbara B. Emerson ◽  
Arnold L. Smith
Keyword(s):  
Rapid Detection ◽  
Type B ◽  
Early Discontinuation ◽  
Ampicillin Resistance ◽  
Hemophilus Influenzae ◽  
Drug Of Choice ◽  
Serious Infections ◽  
Lactam Ring ◽  
Resistant Strains ◽  
Hemophilus Influenzae Type B

Chloramphenicol is presently the drug of choice in the initial treatment of serious infections due to Hemophilus influenzae type b. Rapid detection of ampicillin resistance in clinical isolates would facilitate early discontinuation of chloramphenicol therapy in patients infected with ampicillin-sensitive bacteria. A total of 160 strains of H. influenzae type b were tested with a one-hour acidimetric microassay for β-lactamase activity. All ampicillin-resistant strains rapidly hydrolysed the β-lactam ring of penicillin. When isolates were encoded and tested without knowledge of their MICs, the 40 ampicillin-resistant strains (MIC ≥ 2µg/ml) were readily distinguished from 120 sensitive strains. Rapid β-lactamase assay is therefore a reliable detector of ampicillin resistance in H. influenzae type b.

RESPONSES OF CHILDREN IMMUNIZED WITH THE CAPSULAR POLYSACCHARIDE OF HEMOPHILUS INFLUENZAE, TYPE b

PEDIATRICS ◽  
1973 ◽  
Vol 52 (5) ◽  
pp. 637-644
Author(s):  
David H. Smith ◽  
Georges Peter ◽  
David L. Ingram ◽  
A. Lynn Harding ◽  
Porter Anderson
Keyword(s):  
Capsular Polysaccharide ◽  
Geometric Mean ◽  
Antibody Concentration ◽  
Antibody Activity ◽  
Antigen Binding ◽  
Type B ◽  
Intramuscular Dose ◽  
Hemophilus Influenzae ◽  
Age Dependent ◽  
Hemophilus Influenzae Type B

One hundred forty-one children of 5 to 59 months of age were immunized with a single intramuscular dose of 0.67, 3.3, 17, or 67µg polyribophosphate (PRP), the capsular antigen of Hemophilus influenzae, type b. The immunizations were well tolerated, particularly at doses of .67 to 17µg. Antibody activity was measured by radioactive antigen binding, using 3H-labelled PRP. Doses of 3.3 and 17µg produced significant antibody rises in nearly 90% of recipients; 0.67 and 67µg in approximately half. The geometric mean titers were similar at three and six weeks after immunization and were greater with the middle doses. The net antibody increase in responding children was strongly age dependent, but was not related to the preimmunization antibody concentration. Rises in serum bactericidal activity against H. influenzae type b generally accompanied rises in antibody concentration as measured by the antigen-binding assay.

Sign in / Sign up

Export Citation Format

Share Document