What is the prognosis of Haemophilus influenzae type b (Hib) meningitis?

Updated: Jul 09, 2018
  • Author: Prateek Lohia, MD, MHA; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

The mortality rate of Hib meningitis is 15-20% overall and is higher in very young infants (ie, < 2 mo), in individuals who have immunodeficiencies, and in children who present with fulminant meningitis.

Analysis of 127 studies carried out in a wide variety of international locations has shown an overall international mean case-fatality rate of 13.8% (median, 10%; range, 0-65%). The overall mean case-fatality rate in industrialized nations was found to be 3.2%, while in developing nations this mean rate was 17%. The European mean rate was 4.1%, as compared with 27.6% in Africa. [2]

Approximately 45% of children who have had Hib meningitis recover without sequelae. From 15-25% are left with mild neurologic impairment, 20-40% have significant neurologic impairment, and 10% experience severely handicapping neurologic sequelae. Other long-term problems that are experienced by children who have had Hib meningitis include epilepsy, hemiparesis, and hearing loss.

Delays in diagnosis and treatment likely increase both morbidity and mortality. It remains unclear whether the success of immunization programs will blunt sensitivity to the diagnosis of Hib meningitis and delay initiation of appropriate therapies, thus secondarily enhancing both morbidity and mortality in the small residual population of children that develop Hib meningitis despite population or personal vaccination. For obvious reasons, delay in diagnosis and treatment may be much greater in countries with inadequate infrastructure.

Population-based mortality and morbidity rates remain very high in some developing countries because of lower rates of vaccination and because of decreased accessibility to early standard treatment for Hib meningitis and its various complications. Other factors (eg, nutrition) may also play roles in very high morbidity and mortality rates in such regions.

The emergence of resistant organisms also increases morbidity and mortality where such agents are the cause of meningitis, perhaps by as much as 3-fold. [19] This too is a problem faced more commonly in developing nations that have inadequate immunization programs.


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