ABSTRACT
OBJECTIVE: Due to the higher incidence in invasive infections, the changes observed in the sensitivity of this microorganism during the last decade and the seriousness of pulmonary infections in children, the objective of this paper is to review the clinical and epidemiological characteristics of Haemophilus influenzae type b (Hib) pneumonia, as well as to give an update of treatment. PATIENTS AND METHODS: Twenty-four children diagnosed between 1973 and 1992 are reviewed using the following criteria: clinical manifestations of pneumonia, radiology and isolation of the microorganism. RESULTS: The annual average was 7.8 cases/100,000 children under 5 years of age. More females were affected (58.3% vs 41.6%). Of the cases studied, 58.3% of the children were under one year and 83.3% under 2 years of age. Fever was the most common clinical manifestation (95.8%). Blood cultures were positive in 21 cases (87.5%); pleural effusion culture contributed to the diagnosis in two other cases (8.3%) and deep bronchial aspirate in one other case. Of the Haemophilus influenzae type b strains 62.5% were resistant to ampicillin and 100% were sensitive to second and third generation cephalosporins. Three infants with chronic illness died (12.5%). CONCLUSIONS: Hib pneumonia is an infection usually affecting children younger than 2 years of age. Its clinical manifestations are indistinguishable from those of other microorganisms. Blood culture is the most useful technique to confirm the diagnosis. The increase in resistance to classical treatment (ampicillin) obliges us to consider amoxicillin-clavulanic as the selected empirical treatment. Second and third generation cephalosporins may be considered a good alternative. There is a high mortality in children with chronic illness.
Subject(s)
Haemophilus influenzae/isolation & purification , Pneumonia/diagnostic imaging , Pneumonia/microbiology , Anti-Bacterial Agents , Child , Child, Preschool , Female , Humans , Infant , Lactams , Male , Pneumonia/drug therapy , Radiography , Retrospective StudiesABSTRACT
A new case of pneumococcal meningitis in a child successfully treated with imipenem-cilastatin after failure of standard antibiotics is presented. Seizures, as the major adverse effect, were easily treated and no sequelae were later observed. The difficulty in distinguishing between seizures due to meningitis and those due to imipenem is discussed. We conclude that imipenem-cilastatin is a good alternative therapy in children's meningitis caused by pneumococcus resistant to standard antibiotics.