Recurrent Meningitis Caused by β-Lactamase-Positive Amoxicillin/Clavulanate-Resistant Non-Typeable Haemophilus influenzae in a Child with an Inner Ear Malformation: A Case Report
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Infections with Haemophilus influenzae type b have been decreasing due to widespread use of conjugate vaccines thereto, and there has been an increasing trend in the relative proportion of invasive infections by non-typeable H. influenzae (NTHi). NTHi commonly colonizes the upper respiratory tract and causes recurrent infections of the adjacent organs. There is a rapid development of antibiotic resistance in NTHi strains, and therefore it is important to select appropriate antibiotics for treatment. We report a case of recurrent NTHi meningitis in a 5-year-old girl with a previous history of recurrent otitis media. The patient presented with fever accompanying recurrent vomiting, and β-lactamase-positive amoxicillin/clavulanate-resistant NTHi was isolated in cerebrospinal fluid culture. Antibiotic resistance testing revealed penicillin-binding protein 3 mutation, which is an important emerging mechanism of antibiotic resistance of NTHi. Cystic cochleovestibular malformation was also identified, which may be the predisposing condition for recurrent otitis media, and invasive NTHi infection. Acute symptoms resolved with antibiotic therapy (cefotaxime, 200 mg/kg per day). After surgical revision, the patient has been in good health without recurrence. In children with recurrent respiratory tract infections, or invasive NTHi infection, it is important to consider the presence of underlying diseases and infections due to antibiotic resistant pathogens, in order to select an appropriate antibiotic agent for treatment.
Abstract
Infections with Haemophilus influenzae type b have been decreasing due to widespread use of conjugate vaccines thereto, and there has been an increasing trend in the relative proportion of invasive infections by non-typeable H. influenzae (NTHi). NTHi commonly colonizes the upper respiratory tract and causes recurrent infections of the adjacent organs. There is a rapid development of antibiotic resistance in NTHi strains, and therefore it is important to select appropriate antibiotics for treatment. We report a case of recurrent NTHi meningitis in a 5-year-old girl with a previous history of recurrent otitis media. The patient presented with fever accompanying recurrent vomiting, and β-lactamase-positive amoxicillin/clavulanate-resistant NTHi was isolated in cerebrospinal fluid culture. Antibiotic resistance testing revealed penicillin-binding protein 3 mutation, which is an important emerging mechanism of antibiotic resistance of NTHi. Cystic cochleovestibular malformation was also identified, which may be the predisposing condition for recurrent otitis media, and invasive NTHi infection. Acute symptoms resolved with antibiotic therapy (cefotaxime, 200 mg/kg per day). After surgical revision, the patient has been in good health without recurrence. In children with recurrent respiratory tract infections, or invasive NTHi infection, it is important to consider the presence of underlying diseases and infections due to antibiotic resistant pathogens, in order to select an appropriate antibiotic agent for treatment.
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