Haemophilus influenzae meningitis in the presence of cerebrospinal fluid shunts

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Abstract
Haemophilus influenzae is an uncommon pathogen in shunted patients and there is uncertainty about optimal management. We report here two cases which were managed differently, with different outcomes. The first case was treated with chloramphenicol and the shunt was not removed. Although there were subsequent episodes of respiratory infection, the outcome was satisfactory. The second case was treated with cefuroxime and the shunt was exteriorized. Re-shunting was followed by relapse and further shunt removal. This and other case reports suggest that in Haemophilus meningitis in shunted patients treatment need not involve shunt removal, but that this is so only if appropriate antimicrobials such as chloramphenicol are used.