Meningitis

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Meningitis

Author: Pediatric Oncall

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Case Report: - A 7 year old girl born of non consanguineous marriage presented with headache for 5 days and vomiting for 2 days. She had a blunt injury over right knee 15 days ago followed by swelling and tenderness and treated with antibiotics and crepe bandage for same. In view of headache, a fundus examination was done which showed bilateral papilledema. She was then referred for further management. She was treated for Tuberculosis a year ago in view of Mantoux positivity and received anti tuberculous therapy {ATT} for 6 months. On examination, she was irritable, had hyperventilation, neck stiffness and heavy head. Fundus showed papilledema. Other systems were normal. Investigations showed:

• Hemoglobin = 7.5 gm, dl
• WBC count = 21,600, cumm {84 percent polymorphs, 16 percent lymphocytes}
• Platelet count = Increased on smear
• ESR = 143 mm at end of 1 hour
• MRI brain = Mild dilatation of temporal horns of lateral ventricles
• CSF = 1150 cells, cumm {70 percent polymorphs, 30 percent lymphocytes} sugar of 14 mg percent and proteins of 57 mg percent.
• CSF latex = Positive for H. influenza B and negative for pneumococci, meningococci and E. coli
• HIV = Negative
• Chest X-Ray = Normal
• USG knee = Hematoma
• USG Abdomen = Homogenous, hypoechoic area measuring 1.7 x 1.4 x 1 cm in bladder {_? fungal ball, _?organized debris.}

She was treated with IV Ceftriaxone but had no improvement and then shifted to Meropenam. A repeat CSF still showed 1,800 cells, cumm with 95 percent polymorphs and sugar of 3 mg percent. The child has no fever. CSF again after a week showed 7,200 cells, cumm and sugar of 15 mg percent. CSF cryptococcal india ink preparation is negative. Urine culture grew candida. Thus Fluconazole was also added but headache continued. A repeat CT brain after 7 days was same. Her CSF fungal culture, CSF cryptococcal antigen and India ink preparation was negative. She gradually improved after 10 days.

Is H. influenza cause of her meningitis at this age_?

Answer Discussion :

M

Muraliraj N

0

H influenza can cause meningitis in this age group, even though rare.. It will be better to do a CT head with bone cuts to look for any fracture skull {CSF leak}

15 years ago

M

mamdo hssca

0

H.influenza b meningitis

15 years ago

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Answer 1

Thanks for the info. We also think this is Hib but the age is so unusual. DOes that mean that we should immunize children even above 5 years of age for HIb.

Meningitis

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