Article in Japanese

Bacterial meningitis occurring 18 months after basal skull fracture in a four-year-old boy

Hanae SUGIURA¹⁾, Yasuhiro IKAWA¹⁾, Natsumi INOUE¹⁾, Akiko KATO¹⁾, Mondo KURODA¹⁾, Akihiro YACHIE¹⁾

Routine vaccination with Haemophilus influenzae type b (Hib) polysaccharide vaccine and pneumococcal conjugate vaccine (PCV) has contributed to a substantial reduction in the occurrence of bacterial meningitis. However, bacterial meningitis that develops after vaccination with these agents predisposes its patients to anatomical abnormalities, immune deficiencies and chronic infections. Early diagnosis of potential primary diseases improves overall outcomes and is of paramount importance in preventing further episodes of life-threatening bacterial meningitis. This study describes a four-year-old boy who developed pneumococcal meningitis 18 months after a persistent basal skull fracture. As the patient had already completed a course of vaccinations including Hib vaccine and PCV, his history of a basal skull fracture with cerebrospinal fluid rhinorrhea was considered. A small defect in the basal skull was detected and repaired in this study. Such defects can lead to bacterial meningitis not only immediately, but also several months or years after an injury. A history of head trauma can be overlooked, resulting in recurrent infection with severe neurological sequelae. Therefore, it has been suggested that patients with bacterial meningitis who have already completed Hib and PCV vaccination should be monitored carefully in order to avoid recurrence of this disease.

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1) The Department of Pediatrics, Kanazawa University Hosptital

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Received	September 12, 2016
Accepted	January 31, 2017

29 (1)：39─47,2017