Beta-lactamase-negative ampicillin-resistant Haemophilus infuenzae type b meningitis in partially immunized immunocompetent child: a case report

Abstract

Introduction: Haemophilus infuenzae is a Gram-negative coccobacillus that can cause many diferent kinds of infection, ranging from mild ear infection to life-threatening diseases like epiglottitis and meningitis. Encapsulated type b Haemophilus infuenzae was most commonly responsible for Haemophilus infuenzae meningitis in children before introduction of Haemophilus infuenzae conjugate vaccine. None or partially immunized children are acquiring meningitis owing to resistant strains of Haemophilus infuenzae, namely beta-lactamase-negative ampicillin-resistant strain.

Case presentation: We reported the case of a 2-year-old Emirati boy who presented to our emergency department with fever, diarrhea, vomiting, and fuctuating levels of consciousness. He was developmentally normal with no signifcant past medical history, except he was partially immunized. Earlier, he had been treated for acute gastroenteritis with intravenous fuids and antiemetics in another hospital and was discharged. His parents escorted him to our emergency department as he became very drowsy. Examination revealed that he was in septic shock. He was immediately treated with oxygen, intravenous antibiotics, and fuids after performing septic workup. He was then shifted to intensive care unit. Blood culture and cerebrospinal fuid Gram stain confrmed diagnosis of beta-lactamase-negative ampicillin-resistant Haemophilus infuenzae. He was started on intravenous ceftriaxone, acyclovir, and dexamethasone. He still spiked fever after 1 week. Therefore, ceftriaxone was replaced by meropenem. He recovered well with no sequelae.

Conclusion: This case highlights atypical presentation of life-threatening illness along with microbial resistance that had positive outcome due to timely diagnosis and aggressive management by a multidisciplinary team.