medchick
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Guys I'm confused, first aid says that S. pneumoniae is the leading cause of meningitis in children 6 mths - 6 yrs....BUT....kaplan Q-bank says its H. influenzae (type b)....which is it ???
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| mjl1717
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Strep
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| medchick
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Thanks mjl1717 
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| PatriciaLim
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Thought theres a range of bugs that cause meningitis in 6 months to 6 years
From most common to least common
Strep Pneumonia
N meningitis
H influenza B
Enteroviruses
First aid
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| tolito
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I think h inf used to be the most common cause but now it is strep p.
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| mitty
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may be the q specificaly ask about meningitis in non immunized child.
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| bactitech
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Pre-1985 [21 years ago - I would guess most of you are in your early to mid-twenties], H. influenzae was indeed the most common isolate from CSF in small children. I would guess that virtually all of you kids out there were vaccinated as children and your moms had one less worry on the meningitis front. We used to see it quite frequently. After the HIB vaccine came (my daughter was 5 at the time) it pretty much did away with H. influenzae in CSF. Most new microbiologists have never seen it in CSF. We were warned in training to look very closely at the background on a CSF gram stain, as the organism is very small and tiny. I still teach new students to always look at the background closely on all smears, as gram negative rods do NOT jump out at you like gram positives do. Nothing like dating myself  .
So, in answer to your question, I guess it comes down to what years Kaplan is talking about - pre-HIB or post-HIB vaccine. In the non-immunized child, I guess I would vote for H. influenzae.
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| cool_guyp4u
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Even in the non-immunized child, if there is no source of infection of H I as common as Strep. how can it be common?
HI is no longer the commonest because vaccine has reduced the incidence of this type of meningitis.
Strep pneumoniae has a vaccine too but newer drug resistant types are emerging. So, it still remains the # 1 cause.
bactitech wrote:Pre-1985 [21 years ago - I would guess most of you are in your early to mid-twenties], H. influenzae was indeed the most common isolate from CSF in small children. I would guess that virtually all of you kids out there were vaccinated as children and your moms had one less worry on the meningitis front. We used to see it quite frequently. After the HIB vaccine came (my daughter was 5 at the time) it pretty much did away with H. influenzae in CSF. Most new microbiologists have never seen it in CSF. We were warned in training to look very closely at the background on a CSF gram stain, as the organism is very small and tiny. I still teach new students to always look at the background closely on all smears, as gram negative rods do NOT jump out at you like gram positives do. Nothing like dating myself . So, in answer to your question, I guess it comes down to what years Kaplan is talking about - pre-HIB or post-HIB vaccine. In the non-immunized child, I guess I would vote for H. influenzae.
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| bactitech
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You make a good argument. We just don't see H. influenzae around as much as it used to be, even in adults with pneumonia. We did have a good smear of one the other night, and I made more for our monthly gram stain proficiency testing (I'm in charge of that, heh heh) because a lot of people just don't see this bug on smears any more.
Strep. pneumoniae is indeed more resistant than it used to be. When I went through MT training in 1973-4, this organism was universally sensitive to penicillin. Susceptibility testing was never done. A few years later, there were rumors of resistant strains showing up somewhere in Africa. This was probably in the early 80's. Now we have many strains that are multiply resistant. We screen all our S. pneumo's with oxacillin discs first. We don't drop a penicillin disc for this organism, but use oxacillin that, if it is sensitive, is interpretable to penicillin. I know there's a technical reason, but it eludes me at the moment. If this screen shows pen is resistant, then we run about 5-6 other drugs, but only if it is pen resistant. I think with blood cultures we run everything all at once, though, to save a day.
If you take any one thought away from this thread, it should be that you cannot assume that S. pneumoniae is always sensitive to penicillin any more.
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