Recrudescence and relapse of meningococcal meningitis and septicaemia

Neisseria meningitidis serogroup B meningitis relapse after five days of cefotaxime treatment: what went wrong?

The authors describe a case of relapse of Neisseria meningitidis serogroup B meningitis in a 21-y-old male, 48 h after a 5-day treatment with cefotaxime 215 mg/kg per day. Brain magnetic resonance imaging (MRI) excluded the hypothesis of cerebral abscess or central venous septic thrombosis, and transthoracic echocardiography excluded bacterial endocarditis. Complement, properdin, and protein electrophoresis were normal. The plausible explanations for this relapse and the implications for other similar cases are discussed.

Cerebral abscess associated with meningococcal meningitis

Purulent fluid collections, including brain abscess and subdural empyema, are exceedingly rare in association with meningococcal meningitis. We present a 5-month-old infant with meningococcal meningitis and sepsis complicated by an intracerebral abscess.

Rapid sterilisation of cerebrospinal fluid in meningococcal meningitis: Implications for treatment duration

AIM

The aim of this study was to determine the time and total cumulative dose of parenteral antibiotic, required to sterilize the cerebrospinal fluid (CSF) of children presenting with meningococcal meningitis (MM).

METHODS

The study was a retrospective audit of children aged 0-14 years who presented between January 1995 and December 1999 with MM. All cases had a delayed lumbar puncture (LP) at least 1 h after commencing antibiotic therapy and demonstrated at least one of the following: (i) a positive CSF culture of Neisseria meningitidis (n = 6); (ii) Gram negative diplococci on Gram stain (n = 16) or (iii) a positive CSF plasma clearance rate test for N. meningitidis (n = 26).

RESULTS

Forty-eight children were identified with a mean age of 4.4 years. The cumulative dose of antibiotic prior to LP, ranged from 22 to 440 mg/kg body weight. All cases (n = 24) who received a cumulative dose of at least 150 mg/kg of antibiotic, prior to LP, had a sterile CSF. No CSF taken more than 5 h after commencing antibiotics grew N. meningitidis.

CONCLUSIONS

Children in this study with MM had rapid sterilisation of the CSF in less than 6 h. This would support recent recommendations to reduce the duration of antibiotic therapy to 4 days. There is however, lack of long-term data on sequelae with 4 days of treatment.