Haemophilus influenzae Type f Meningitis Complicated by Bilateral Subdural Empyema, Central Venous Thrombosis, and Bilateral Sensorineural Hearing Loss in an Immunocompetent 12-month-old

Abstract

Haemophilus influenzae is a gram-negative coccobacillus that colonizes the nasopharyngeal surface and upper respiratory tract of healthy individuals and includes six encapsulated serotypes as well as non-encapsulated, non-typeable strains. Since the widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine implemented in 1990, the majority of invasive illness now seen in the United States is secondary to capsular serotypes other than type b and non-typeable strains with the largest burden of disease affecting the extremes of age-infants and the elderly. We report a case of acute Haemophilus influenzae type f meningitis in a 12-month-old female who was previously healthy and had been fully immunized. She demonstrated clinical improvement on ceftriaxone, but persistent fever and ear-tugging resulted in obtaining an MRI that displayed bilateral subdural empyemas requiring burr-hole craniotomy, central venous thrombosis requiring anticoagulation, and bilateral sensorineural hearing loss requiring cochlear implants. Immunological studies confirmed immunocompetency and appropriate response to her previous Hib vaccination, suggesting a significant impact of bacterial virulence. These complications, with the exception of sensorineural hearing loss, have not been reported in the literature for Haemophilus influenzae type f and should be considered in the care of these patients despite clinical appearance given the severity of complications and potential for acute decompensation. Despite the success of vaccination in reducing invasive disease, cases of H. influenzae meningitis continue to occur via less common encapsulated serotypes with unknown complications, making the management and treatment of these infections more difficult for practitioners.

Long Term Impact of Conjugate Vaccines on Haemophilus influenzae Meningitis: Narrative Review

“…There were 185 cases of Hif infection in adults aged ≥ 40 years with meningitis accounting for 15% [ 126 ]. Hif meningitis has also been reported in the United States [ 127 , 128 , 129 ] and in Sweden [ 130 ].…”

Nontypeable Haemophilus influenzae Otitis Media: Mastoiditis and Meningitis Complicated with Central Venous Thrombosis in an Immunocompetent Child

“…To our knowledge, CSVT has not been reported in the literature for NTHi. Still, previously, a 12-month-old immunocompetent female developed meningitis caused by Haemophilus influenzae type F complicated bilateral subdural empyemas, central venous thrombosis, and bilateral sensorineural hearing loss requiring cochlear implants [ 22 ]. Treatment of otogenic CVST includes appropriate antibiotic therapy for 4–6 weeks, and operative management ranges from myringotomy with ventilation tube placement alone to myringotomy, tube placement, and mastoidectomy.…”

Invasive Haemophilus influenzae Type F Infection Complicated by Subarachnoid Phlegmon and Cortical Venous Thrombosis

“…H influenzae is strictly a human pathogen, gram-negative coccobacillus, which usually infects the upper respiratory tract and can cause serious invasive infections, especially in children younger than 5 years. [1][2][3][4][5][6][7][8] There are 6 encapsulated serotypes characterized by distinctive capsular polysaccharides (a-f), as well as 3 nonencapsulated or nontypeable strains. 2,3,7 In 1994, invasive Hif was reported to occur at frequency of 1.9 cases per 1 million children with pneumonia and meningitis being the most common presentations.…”

“…[12][13][14] In the pediatric population, pneumonia and meningitis are the most common forms of severe Hif infection. 1,8 Interestingly, the majority of invasive non-typeable Hif cases occur in immunocompetent patients who have no predisposing risk factors. 7 Nontypeable H influenzae vaccines are currently under investigation.…”