Meningococcal meningitis: an atypical case

A case of meningococcal meningitis is described in a patient who had not received antibiotics before admission. Three lumbar punctures were performed over a seven-day period, but only the cerebrospinal fluid from the third yielded a positive culture. The importance of repeated lumbar punctures in patients with undiagnosed meningitis is emphasized.     

Cerebral herniation during bacterial meningitis in children.

OBJECTIVE--To see whether the incidence of cerebral herniation is increased immediately after lumbar puncture in children with bacterial meningitis and whether any children with herniation have normal results on cranial computed tomography. DESIGN--Retrospective review of case notes; computed tomograms were read again. SETTING--Large paediatric teaching hospital. SUBJECTS--445 children over 30 days old admitted to hospital with bacterial meningitis. MAIN OUTCOME MEASURES--Timing of herniation in relation to lumbar puncture; findings on computed tomography in children with herniation. RESULTS--Cerebral herniation was detected in 19 (4.3%) of the 445 children (21 episodes; herniation occurred twice in two children). Herniation occurred in 14 (45%) of the 31 children who died. Nineteen episodes of herniation occurred in the 17 children who had a lumbar puncture; 12 of the episodes occurred in the first 12 hours after the lumbar puncture and seven over six other 12 hour periods (odds ratio 32.6 (95% confidence interval 8.5 to 117.3); p < 0.001). The results of cranial computed tomography were normal in five (36%) of the 14 episodes of herniation in which scanning was performed at about the time of herniation. CONCLUSIONS--The temporal relation between lumbar puncture and herniation strongly suggests that a lumbar puncture may cause herniation in some patients, and normal results on computed tomography do not mean that it is safe to do a lumbar puncture in a child with bacterial meningitis.     

Meningococcal disease in Scandinavia.

Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprises with mutual borders and 22.3 million inhabitants an area where the socioeconomic and cultural conditions are similar. Epidemic diseases, such as meningococcal infection, might therefore be expected to be uniformly distributed. An epidemiological study in the 10-year period 1970-9 shows, however, remarkable differences in the incidence, age, and serogroup and type distribution, as well as in the general dynamics of the disease. Three epidemics, two caused by different serotypes of group B (Norway and Iceland) and one by group A (Finland) occurred within the observation period. The annual overall incidence was generally around 3/100 000 but increased from fivefold (Finland) to eightfold (northern Norway) during epidemics. The epidemic strains caused infection in over 3000 patients and the loss of at least 250 lives. The overall case fatality rate was 8.6% (range 4.1-13.7%). Men were more susceptible and had a worse prognosis than women of the same age group. The group A epidemic in Finland was influenced by a large vaccination campaign, but this possibility was not feasible in the two other epidemics.