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Hib 0% (0/16), respectively, p 0.01]. Among these 13 cases, seven check details were iatrogenic (four cases after neurocranial surgery; three after surgery for sinusitis, mastoiditis or cholesteatoma), five patients had a history of head trauma and one patient had a tympanic membrane defect of unknown origin. Underlying disease.? While none of the children had an underlying disease, five adults (17%) had an underlying disease [cancer (n?=?3), diabetes mellitus (n?=?2)]. All five adults were infected with non-Hib. Focus of infection.? Otitis media was the most frequent primary focus of infection and was present in 38% (25/65) of all cases. Five of these patients also had mastoiditis. Pneumonia and sinusitis were present in 12% (8/65) and 8% (5/65) of cases, respectively, whereas the focus of infection was unknown in 47% (30/65) of cases. The focus of infection was not significantly associated with the age group of the patient. However, children infected with Hib more frequently had an unknown focus when compared with children infected with non-Hib [63% (10/16) vs. 23% (3/13), respectively, p 0.06]. Prehospital diagnostic and therapeutic management.? A GP was consulted prior to hospitalization in 42% (26/62) of cases. Children had significantly increased frequency of fever prior to hospitalization compared with adults (72% vs. 31%, respectively, p 0.001). Prior to admission, 24% (14/58) of patients had received antibiotic treatment with a ��-lactam [therapy with phenoxymethylpenicillin and aminopenicillins in 71% (10/14) and 29% (4/14) of cases, respectively], and all of the H.?influenzae strains isolated Dinaciclib from these patients appeared to be ampicillin susceptible (13/14; no susceptibility testing data were available for one case). Clinical characteristics.? Meningitis was the tentative Terminal deoxynucleotidyl transferase diagnosis of the admitting physician in 86% (55/64) of cases. Upon admission, classical signs of purulent meningitis were present in a majority of patients, and 92% of patients (59/63) received a lumbar puncture on the day of admission. Fever was present in 88% (46/52) of patients, back rigidity in 75% (43/57), and an altered mental status in 72% (42/58) (ranging from decreased responsiveness or confusion to coma). Convulsions occurred in 19% of cases (11/57) and more frequently in children [30% (8/27) than in adults 10% (3/30) (p 0.05)]. In addition, 47% (17/36) of adult patients had headache and 47% (7/15) of children