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Meningococcal meningitis presenting postinfant group B meningococcal immunisation
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  • Published on:
    Comment to Response by M Nadeem to Letter ‘Meningococcal Meningitis Post-Infant Group B Meningococcal Immunisation’
    • Rani Pal, Consultant Paediatrician Children’s Services, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
    • Other Contributors:
      • Neda So, Medical Officer
      • Matthew D Snape, Consultant General Paediatrician and Vaccinologist

    Dear Sir,

    We thank Dr Nadeem, for highlighting that the clinical features of drowsiness and infant focal seizures in our case report indicates that early treatment for viral/herpes encephalitis was an imperative.

    We would like to reassure Dr Nadeem that our infant did indeed receive a combination of early intravenous antiviral treatment (acyclovir) and antibiotics (cefotaxime and amoxicillin) and this was continued until final viral/bacterial PCR and CSF culture results were obtained. The use of acyclovir and amoxicillin was omitted from the original report due to word count limitations.

    Viral PCR tested was negative for a range of viruses including herpes simplex (HSV). Although PCR assay is an important diagnostic modality for viral encephalitis HSV, we would add that due to focal seizures, our infant case received investigations and treatment as per national (1) and local guidelines: immediate brain CT imaging was performed to exclude neurosurgical conditions, and a later cranial MRI scan did not show selective damage to the mesial temporal lobe structures or the hippocampus. In addition, an early electroencephalogram (EEG) was normal. The EEG severity and the presence of epileptic seizures at the initial presentation would be significant indicators for predicting the 6-month clinical outcome in patients with HSE.

    The seriousness of HSV CNS infections suggests that clinicians maintain a high index of suspicion to initiate evaluation under s...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re: letter Meningococcal meningitis presenting postinfant group B meningococcal immunisation. doi: 10.1136/archdischild-2018-316341
    • Montasser Nadeem, Paediatric Consultant; Senior Clinical Lecturer Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland; Trinity College Dublin

    M Nadeem
    1. Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland
    2. Trinity College Dublin

    Corresponding author: M Nadeem, Department of Paediatrics, Tallaght University Hospital, Dublin 24, Ireland

    So et al1 reported a case of meningococcal group W meningitis in an infant who presented within 24 hours of receiving group B meningococcal vaccine (4CMenB). Fever and focal seizure, which required two doses of intravenous lorazepam, have been reported at the time of presentation. Intravenous ceftriaxone was commenced for suspected sepsis. CSF PCR was positive for capsular group W meningococcus. With respect to the focal seizure in a febrile infant, whether viral encephalitis was excluded and whether antiviral was commenced pending the exclusion of herpes simplex encephalitis (HSE) are questions that were not addressed in the present case.

    At the time of presentation, it may not be possible to clinically differentiate encephalitis from meningitis, as either syndrome may have common features including fever, headache and meningism.2 Children with encephalitis may present with fever, seizures and focal neurological signs.2 3 Moreover those with HSE may experience a progressively deteriorating level of consciousness with fever, focal seizures or focal neurological abnormalities in the absence of any other cause.2 4 However the absence of fever2 5 or the lack of altered states of consciousness5 at presentation does not exclude...

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    Conflict of Interest:
    None declared.