Haemophilus Influenzae B Disease

Nitin Shah
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HIB-mortality
Meningitis & epiglottitis are 2 common cases of mortality. In west the mortality is low & is 3-5%. In developing countries it is as high as 30-50 % due to suboptimal health care system & access (2,4,7). It is estimated that world over 3,75,000 children die due to Hib every year. In India, the IBIS study has shown that the mortality due to meningitis is 30% in <1 yr old children & 10% in >1 yr old. Similarly mortality due to non-meningitis Hib cases is 10% (8). The mortality is likely to increase due to increasing drug resistance.

Of late there is increase in the incidence of drug resistance in Hib. Ampicillin resistance was reported in 1974, chloramphenicol resistance in 1978. Both ampicillin and chloramphenicol resistant strains were reported in 1980 from UK, USA, Bangkok & Spain (12). Since then multidrug resistance mediated by R plasmid has spread all over world posing therapeutic challenges, threatening to increase mortality & increasing cost of treatment.

1st multidrug resistant strain causing meningitis in India was reported from Chandigarh which proved fatal (12). This was followed by 2 more cases reported from Pondicherry & one more case from Chandigarh in 1990 (13). Use of cefotaxime saved this child. Large study from Vellore in 1992 reported that 42.5% of total Hib cases were MDR strains with 80% resistant to ampicillin, 90% to chloramphenicol & sulpha drugs & none to cefotaxime (4,7). This prompted them to use 3rd generation cephalosporins as first line drug in cases of meningitis as mortality was 100% in MDR cases if cefotaxime was delayed. This is in contrast to UK where between 1985-90 only 12.5% strains were resistant to ampicillin & none to chloramphenicol. The increased incidence of MDR in India was be related to widespread misuse of antibiotics in general population. Similar report from Nagpur in 1996 showed that 80% of Hib infants were resistant to both ampicillin and chloramphenicol (14). In 1996 the second report from Vellore showed 30% resistance to ampicillin, 17% to chloramphenicol and 15% to both these drugs (4,7). Lastly IBIS study has shown 56% resistance to chloramphenicol, 40% to ampicillin & none to 3rd generation cephalosporin (8).


References
Haemophilus Influenzae B Disease Haemophilus Influenzae B Disease 04/09/2001
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