Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Purulent meningitis in children younger than age 4 years with direct smears of CSF showing gram-negative pleomorphic rods Acute epiglottitis: high fever, drooling, dysphagia, aphonia, and stridor Septic arthritis: fever, local redness, swelling, heat, and pain with active or passive motion of the involved joint in a child 4 months to 4 years of age Cellulitis: sudden onset of fever and distinctive cellulitis in an infant, often involving the cheek or periorbital area In all cases, a positive culture from the blood, CSF, or aspirated pus confirms the diagnosis +++ General Considerations ++ H influenzae type b (Hib) has become uncommon because of widespread immunization in early infancy The 99% reduction in incidence seen in many parts of the United States is due to high rates of vaccine coverage and reduced nasopharyngeal carriage after vaccination Hib may cause meningitis, bacteremia, epiglottitis (supraglottic croup), septic arthritis, periorbital and facial cellulitis, pneumonia, and pericarditis Non–type b encapsulated strains may cause meningitis, bacteremia and other disease similar to Hib +++ Clinical Findings ++ Meningitis Fever Irritability Lethargy Poor feeding with or without vomiting High-pitched cry Acute epiglottitis Evidence of dysphagia, characterized by a refusal to eat or swallow saliva and by drooling High fever Stridor is a late sign Septic arthritis Child is febrile and refuses to move the involved joint and limb because of pain Examination reveals swelling, warmth, redness, tenderness on palpation, and severe pain on attempted movement of the joint Cellulitis Uncommon as a result of immunization Cheek or periorbital (preseptal) area is often involved +++ Diagnosis +++ Laboratory Findings ++ The WBC count in Hib infections may be high or normal with a shift to the left A positive culture of blood, CSF, aspirated pus or fluid from the involved site proves the diagnosis In untreated meningitis, CSF smear may show the characteristic pleomorphic gram-negative rods +++ Imaging ++ A lateral radiographic view of the neck may suggest the diagnosis in suspected acute epiglottitis, but misinter pretation is common Intubation should not be delayed to obtain radiographs +++ Treatment ++ All patients with bacteremic or potentially bacteremic H influenzae diseases require hospitalization for treatment Drugs of choice in hospitalized patients are a third-generation cephalosporin (cefotaxime or ceftriaxone) until the sensitivity of the organism is known Meropenem is an alternative choice Ampicillin is adequate for culture-proved susceptible strains Persons with invasive Hib disease should be in droplet isolation for 24 hours after initiation of parenteral antibiotic therapy Empiric intravenous therapy recommended for meningitis (until organism identified) is vancomycin in combination with either cefotaxime or ceftriaxone Duration of therapy is 10 days for uncomplicated meningitis; longer treatment is reserved for children who respond slowly or have complications Dexamethasone given ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth