Insidious presentation of pediatric pneumococcal meningitis: alive and well in the post vaccine era

Abstract

Routine childhood vaccination against H influenza type b and S pneumoniae has dramatically reduced the incidence of pediatric bacterial meningitis. Because of the decreased incidence of this disease, individual emergency physicians will have limited opportunity to experience the diverse clinical manifestations of this disease. Insidious presentations of this diagnosis still occur but would now be considered rare events for emergency physicians. It is imperative to recognize that young infants with bacterial meningitis can present without fever or irritability and manifest signs and symptoms consistent with many other diagnoses. Careful study of prior cases and sustained clinical vigilance are required to capture these cases. In this report, we present 3 cases of pneumococcal meningitis in young infants presenting with indolent features. None of the patients presented with a chief complaint of irritability, poor feeding, or altered mental status, and no patient had high fever, difficulty consoling, or cirulatory compromise.