Invasive Haemophilus influenzae type b infections in children in Paraguay.
BACKGROUND
In Paraguay, as in most Latin American countries, data on the epidemiology and clinical characteristics of Haemophilus influenzae type b (Hib) diseases are scarce and incomplete.


METHODS
To address this issue, we performed a retrospective analysis of 102 patients admitted to the Instituto de Medicina Tropical, a referral hospital in Asunción, Paraguay, between January 1991 and September 1995 with diagnosis of invasive Hib infection. This study included patients 15 years of age and under-identified with positive cultures for Hib in blood, cerebrospinal fluid, or other sterile body fluids.


RESULTS
Eighty three (81%) patients presented with meningitis as principal focus of infection with median age of 9 months. Forty five (54%) patients with Hib meningitis were <12 months of age and 20 (24% of total cases) were <6 months of age. Overall mortality rate of meningitis was 13%. Of 11 patients who died, 10 (91%) were <12 months of age (p <0.02). Risk for mortality was correlated with presence of coma during admission (p <0.007) and CSF glucose level of <10 mg/dL (p <0.05). Severe sequelae such as bilateral hearing loss, hydrocephalus, and mental retardation were observed in 39% (28/72) of surviving patients, of whom 18 (51%) patients were <12 months of age (p <0.02). Thirty percent of isolated strains of Hib were resistant to ampicillin, 20% were resistant to chloramphenicol, and 10% to both drugs.


CONCLUSIONS
This information provides evidence concerning the importance of continued support for Hib vaccine supplies in immunization programs in countries with limited resources such as Paraguay.
Basualdo
Wilma
W
Departamento de Pediatría, Instituto de Medicina Tropical, Asunción, Paraguay.
Arbo
Antonio
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003128:Coma; D004351:Drug Resistance; D005260:Female; D005947:Glucose / Q000134:cerebrospinal fluid; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000401:mortality; D019741:Haemophilus influenzae type b; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008581:Meningitis / Q000382:microbiology / Q000401:mortality; D010239:Paraguay; D012189:Retrospective Studies
D005947:Glucose