Abstract
In late October 2011, the Monroe County Department of Public Health (MCDPH) was notified of a suspected case of meningitis in a 9-year old girl from Monroe County, NY. Laboratory testing at the New York State Department of Health (NYSDOH) Wadsworth Center confirmed the identification of Haemophilus influenzae serotype e (Hie) isolated from the patient’s cerebrospinal fluid (CSF) using real-time polymerase chain reaction (RT-PCR). The universal immunization of infants with conjugate H. influenzae type b (Hib) vaccine has significantly reduced the incidence of invasive Hib disease, including meningitis, one of the most serious complications for infected children. Not surprisingly, as the epidemiology of invasive H. influenzae continues to change, non-Hib serotypes will likely become more common. The findings reported here underscore the importance for clinicians, public health officials, and laboratory staff to consider non-Hib pathogens in pediatric cases of meningitis, especially when initial investigations are inconclusive.
Highlights
During the pre-Haemophilus influenzae serotype b (Hib) conjugate vaccine era, H. influenzae type b (Hib) was the cause of more than 95% of invasive H. influenzae disease among younger children [1]
As the epidemiology of invasive H. influenzae continues to change, non-Hib serotypes such as Haemophilus influenzae serotype e (Hie) are increasing
We present the case of a patient who was clinically diagnosed with bacterial meningitis but all routine laboratory cultures showed no growth at the local lab
Summary
During the pre-Haemophilus influenzae serotype b (Hib) conjugate vaccine era, Hib was the cause of more than 95% of invasive H. influenzae disease among younger children [1]. The universal recommendation for the immunization of infants in the United States beginning at two months of age with conjugate H. influenzae type b (Hib) vaccine began in 1991 [3]. This has significantly reduced the incidence of invasive Hib disease, including meningitis, one of the most serious complications for infected children. We discuss the importance of public health involvement when a bacterial meningitis case is identified but etiology of the organism is unknown
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