Question

“A Case Study on Bacterial Meningitis and Haemophilus Vaccine”

At half past three one afternoon during late fall of 1987, Catherine received a phone call from her mother. She felt a moment of panic. Was Josephine all right? Catherine worked at a day care center and Josephine, her 34-month-old daughter, was being taken care of by Catherine’s mother during the day while Catherine was at work.

“You have to come immediately. Josephine has a fever, and she is delirious her mother said”.

There was no need for Catherine and her mother to say what they both had on their minds. In the day care center where Catherine worked, two children had recently developed bacterial meningitis. The children had both been given an intravenous 10-day course of cefuroxime, an antibiotic related to penicillin. In both cases, Haemophilus influenza had been cultured from a specimen of cerebrospinal fluid.

Catherine told her mother to wrap Josephine in a blanket, and she hurried home to meet them. On the way to the hospital, it occurred to Catherine that she had forgotten to check Josephine’s condition, because she was so anxious to get to the hospital. As they approached the hospital, Josephine was unconscious. A sample of Josephine’s cerebrospinal fluid showed an increase number of leukocytes (approximately 8 x 109/L). During the late 1980’s, a novel Haemophilus vaccine (Hib vaccine) was developed and shown to protect within the first year of life. Therefore, the risk of such a case occurring at a daycare is very rare.

Questions:

1. What is the pathophysiological role of the leukocytes in the present situation? Comment on the type you would expect to predominate.

2. How sure could you be at this stage, a few hours after admission to the hospital, that Josephine is ill with bacterial meningitis? What other diagnoses might be considered? What bacterial agents other than H. influenza cause meningitis and at what ages? What is the spectrum of illnesses caused by H. influenza? What is the relation between capsular type of H. influenza and pathogenicity?

3. Why did Josephine become ill? Shouldn’t her host defense system have stopped the infection from the beginning? Why or Why not? What are your comments on the choice of antibiotic therapy?

4. Catherine received telephone calls from the director oat the daycare center. The center’s staff was deeply concerned and wished to know the risks for the remaining children of the center and for other center personnel. What should the Center say to the parents? Should all the children receive preventive treatment? Your advice will be very important given that the news media may soon become aware of the present series of cases and a whole region alerted. Prepare a statement to inform parents and the community about the problem.

5. Do you expect the Haemophilus vaccine to protect against epiglottitis and otitis? (ear infection) Explain why or why not?

Answer 1

1. The pathophysiological role of the leukocytes in the present situation are as follows:-

leukocytes are the first line of defense which is involved in inflammatory and hypersensitivity reactions. its recruitment are the key aspect of the protective response against invading microorganisms. Leukocytes migrate towrds the CNS chemotacticaly, first it adhere to the endothelial cells, by the help of specific adhesion molecules (selectins), producing a rolling motion of leukocytes along the endothelium .Then, Heparin interferes with this process and attenuates leukocyte rolling and sticking . In the secondary phase mediated by integrins, leukocytes become strongly adherent, and once it gets firmly attached it migrate between endothelial cell junctions along a chemotactic gradient.

The leucocytes which predominates the CSF fluid is granulocytes mostlly consiting of neutrophils.