The risk of additional systemic bacterial illness in infants with systemic Streptococcus pneumoniae disease

Dexamethasone adjunctive therapy for bacterial meningitis in children: a retrospective study in Brazil

The clinical records of 87 children with bacterial meningitis treated with antibiotics (group 1) and of 92 treated with antibiotics plus dexamethasone (group 2), admitted to the Instituto Materno Infantil de Pernambuco, Recife, Brazil over 2 consecutive years (1991 and 1992), were analysed. There were no significant differences between treatment groups regarding characteristics on admission except that group 1 were younger. The overall case fatality rate was 19%, with 14% in group 2 and 24% in group 1 (p = 0.09). Rate of discharge without sequelae was 70% in the steroid-treated children and 56% in children treated with antibiotics alone (p = 0.07). Among children aged 6-59 months, those treated with dexamethasone compared with those treated with antibiotics alone had a better case fatality rate (11% vs 25%; p = 0.05) and a better rate of discharge without sequelae (73% vs 52%; p = 0.02). Among the cases with a CSF culture positive for Haemophilus influenzae, 77% were discharged without sequelae in group 2 compared with 51% in group 1 (p = 0.03). The addition of dexamethasone to standard antibiotic treatment improves the outcome of children between 6 and 59 months of age admitted to hospital with a diagnosis of bacterial meningitis.

Deficiency of IgG subclasses and IgA, and elevation of IgE in children with a past history of bacterial meningitis

Of 44 children who recovered from an attack of bacterial meningitis, 3 (7%) were found to have IgG subclass deficiency, 5 (11%) had IgA deficiency and 22 (50%) had raised IgE levels. These results suggest that immunoglobulin abnormalities may be an important predisposing factor in some cases of bacterial meningitis.

Immunological paralysis to pneumococcal polysaccharide in man

A 9-month-old infant had severe pneumococcal meningitis and for the next two years showed immunological paralysis to the causal serotype. He remained normally responsive to a protein antigen (tetanus toxoid) and to polysaccharide antigens (Haemophilus influenzae type b capsule and pneumococcal capsule antigens other than the infecting/paralysing serotype). By the fourth year of life the child was spontaneously producing antibody to the infecting/paralysing pneumococcal serotype, at which time rechallenge with the previously tolerising antigen resulted in a secondary response. The occurrence of pneumococcal immunological paralysis in man is therefore validated.

Purpura in occult pneumococcal bacteremia

An unusual case of occult pneumococcal bacteremia is reported. A 4-month-old female presented with ascending purpura on the lower extremities as the only abnormal physical finding. All initial laboratory studies were normal; however, Streptococcus pneumoniae serotype 6 was cultured from her blood within 18 hours and subsequently from the nasopharynx. This is the first reported case in humans of occult pneumococcal bacteremia presenting with the primary clinical finding of purpura. This entity has a well defined animal model in mice.