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I shared this with our ID director (Dr. Mary Anne Jackson), who pointed out that bacterial meningitis appears at this time of year as a complication of influenza:
"Both pneumococcal and meningococcal meningitis can occur post flu as well as GAS and S aureus invasive disease and TSS."

She also addressed Jim's question:  "We do know that new serotypes [of pneumococcus] have emerged but this is not waning immunity because the teen only got PCV7".


Greg Conners

Gregory P. Conners, MD, MPH, MBA, FAAP, FACEP

Director, Division of Emergency Medicine
Associate Chair of Pediatrics
Professor of Pediatrics and Emergency Medicine
Children’s Mercy Hospital, Kansas City
University of Missouri, Kansas City
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-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Wednesday, February 14, 2018 2:25 PM
To: [log in to unmask]
Subject: Re: Bacterial meningitis

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Could you share with us the clinical findings and history that prompted the LP?


Shiu-Lin




Shiu-Lin Tsai, MD
Division of Pediatric Emergency Medicine

Department of Emergency Medicine
Columbia University Medical Center



-----Original Message-----
From: Scott Freedman <[log in to unmask]>
To: PED-EM-L <[log in to unmask]>
Sent: Wed, Feb 14, 2018 2:44 pm
Subject: Bacterial meningitis

ALL:
Since Jan 1st this year, we have seen 3 cases of culture + bacterial meningitis come through are ED;  2 with *Strep pneumoniae* and 1 with *Neisseria meningiditis*.  All 3 were in older children/ teens who received their Prevnar 13  vaccines as well as the Menactra series in the patient with Neisseria.  Anyone else seeing cases of this sort?  I do not recall 3 cases of bacterial meningitis in older kids in a community setting such as ours in quite a long time.  Is this random bad luck or do  we all need to be more vigilant?  Incidentally, none had neck pain or meningismus as a clinical finding.

--
Kind regards,

Scott
Scott Freedman, MD
Medical Director,  Pediatric Emergency Dept Rockville MD

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