Acute Bacterial Meningitis due to Haemophilus influenzae Associated with Cerebrospinal Fluid Fistula Secondary to Recurrent Olfactory Esthesioneuroblastoma and Skull Base Radiotherapy: A Case Report
Main Article Content
Abstract
Background: Acute bacterial meningitis remains a life-threatening neurological emergency requiring rapid diagnosis and immediate antimicrobial therapy [1,2]. In the post–Haemophilus influenzae type b (Hib) vaccination era, invasive H. influenzae infections have shifted toward adult populations with structural skull base abnormalities or other predisposing conditions [3,4].
Case Presentation: We report a 47-year-old woman with a history of recurrent olfactory esthesioneuroblastoma treated with multiple skull base surgeries and radiotherapy. She presented with acute bacterial meningitis preceded by four months of intermittent positional clear rhinorrhea, suggestive of cerebrospinal fluid (CSF) leakage [5,6]. Cerebrospinal fluid analysis demonstrated neutrophilic pleocytosis, hypoglycorrhachia, and elevated protein levels. PCR isolated Haemophilus influenzae. Imaging revealed extensive anterior skull base defects and pansinusitis. The patient received intravenous ceftriaxone and adjunctive dexamethasone, achieving full neurological recovery [7].
Conclusions : Delayed cerebrospinal fluid fistula following skull base oncologic treatment represents an important and potentially underrecognized risk factor for bacterial meningitis. Early identification and definitive surgical repair, in addition to antimicrobial therapy, are essential to prevent recurrence and improve outcomes [5,8,9].
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Villalpando-Carrión S, Henao-Martínez AF, Franco-Paredes C: Epidemiology and clinical outcomes of bacterial meningitis in children and adults in low- and middle-income countries. Curr Trop Med Rep. 2024, 11:60-7. 10.1007/s40475-024-00316-0
II. McGill F, Heyderman RS, Panagiotou S, Tunkel AR, Solomon T: Acute bacterial meningitis in adults. Lancet. 2016, 388:3036-47. 10.1016/S0140-6736(16)30386-8
III. Soeters HM, Blain A, Pondo T, et al.: Current epidemiology and trends in invasive Haemophilus influenzae disease-United States, 2009-2015. Clin Infect Dis. 2018, 67:881-9. 10.1093/cid/ciy187
IV. Slack MPE, Cripps AW, Grimwood K, Mackenzie GA, Ulanova M: Invasive Haemophilus influenzae infections after 3 decades of Hib protein conjugate vaccine use. Clin Microbiol Rev. 2021, 34:e0002821. 10.1128/CMR.00028-21
V. Ter Horst L, Brouwer MC, van der Ende A, van de Beek D: Community-acquired bacterial meningitis in adults with cerebrospinal fluid leakage. Clin Infect Dis. 2020, 70:2256-61. 10.1093/cid/ciz649
VI. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR: Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016, 6:8-16. 10.1002/alr.21637
VII. van de Beek D, Cabellos C, Dzupova O, et al.: ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016, 22 Suppl 3:S37-62. 10.1016/j.cmi.2016.01.007
VIII. Daudia A, Biswas D, Jones NS: Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007, 116:902-5. 10.1177/000348940711601206
IX. Oakley GM, Orlandi RR, Woodworth BA, Batra PS, Alt JA: Management of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016, 6:17-24. 10.1002/alr.21627
X. Proulx N, Fréchette D, Toye B, Chan J, Kravcik S: Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM. 2005, 98:291-8. 10.1093/qjmed/hci047
XI. Peltola H: Worldwide Haemophilus influenzae type b disease at the beginning of the 21st century: global analysis of the disease burden 25 years after the use of the polysaccharide vaccine and a decade after the advent of conjugates. Clin Microbiol Rev. 2000, 13:302-17. 10.1128/CMR.13.2.302
XII. Blain A, MacNeil J, Wang X, et al.: Invasive Haemophilus influenzae disease in adults ≥65 years, United States, 2011. Open Forum Infect Dis. 2014, 1:ofu044. 10.1093/ofid/ofu044
XIII. Schlosser RJ, Bolger WE: Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 2004, 114:255-65. 10.1097/00005537-200402000-00015
XIV. Carnalla-Barajas MN, Soto-Noguerón A, Martínez-Medina L, et al.: Diagnosis of bacterial meningitis caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae using a multiplex real-time PCR technique. Braz J Microbiol. 2022, 53:1951-8. 10.1007/s42770-022-00826-x
XV. Huang XM, Zheng YQ, Zhang XM, et al.: Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma. Laryngoscope. 2006, 116:1626-31. 10.1097/01.mlg.0000230435.71328.b9
XVI. Han P, Wang X, Liang F, et al.: Osteoradionecrosis of the skull base in nasopharyngeal carcinoma: incidence and risk factors. Int J Radiat Oncol Biol Phys. 2018, 102:552-5. 10.1016/j.ijrobp.2018.06.027
XVII. van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR: Advances in treatment of bacterial meningitis. Lancet. 2012, 380:1693-702. 10.1016/S0140-6736(12)61186-6
XVIII. Horowitz G, Fliss DM, Margalit N, Wasserzug O, Gil Z: Association between cerebrospinal fluid leak and meningitis after skull base surgery. Otolaryngol Head Neck Surg. 2011, 145:689-93. 10.1177/0194599811411534