Hemofilové meningitidy u dětí do pěti let věku

Objective: Promote based on an analysis of the clinical course and therapeutic results of bacterial meningitis caused by Haemophilus influenzae type b in children under 5 years during the prevaccination period the initiated blanket immunization against haemophil invasive infections. Material and methods: During the period between 1985 and 1999 at the Infectious Diseases Clinic of the Faculty Hospital Plzeň a total of 150 children aged 5 weeks to 5 years were admitted on account of bacterial meningitis. The etiology of the disease was verified by cultivation of the pathogen or its antigens by latex agglutination in 85.3% cases. Haemophilus influenzae type b (Hib) participated in 44% of the total number of bacterial meningitis. In the group of children where the causal agent was Hib the authors evaluated risk factors, the clinical course of the disease, diagnosis, treatment, complications and sequelae. Results: Cultivation provided evidence of the etiological agent (Hib) in cerebrospinal fluid in 95.5%, in 4.5% in the cerebrospinal fluid Hib antigens were detected only by the method of latex agglutination. In 68% a haemoculture was collected and the pathogen was detected in 49%. Since 1994 the formation of beta-lactamase by different strains of Hib was examined (27 children, 27 strains of Hib detected by cultivation) which was confirmed in 14.8%. Only 44% children were recommended for hospitalization by their paediatrician with the appropriate diagnosis. The mean hospitalization period was 20 days, the mean period of antibiotic therapy 11 days. During hospitalization the disease was most frequently complicated by impaired balance (59.1 %) and nosocomial rotavirus gastroenteritis (33.3%). A subdural effusion was found in 6% of the patients. A rare complication was perforation of a duodenal ulcer in a two-year-old child during the third day of treatment of meningitis. No death was recorded. During the long-term follow-up of children (6 months to 6 years) permanent sequelae were recorded in 20% of sixty cases, incl. impaired hearing in 8.3% patients. Conclusion: The study confirmed the serious character of the disease and the relatively high percentage of permanent sequelae. Initiation of overall immunization of children against invasive haemophil infections is fully justified in the CR.