Concurrent meningococcal and herpes simplex infection in a non-immunocompromised child

Jasmin Ali

Hannah Walsh

Swathi Sanapala

Nadeem Syed

^{Department of Paediatrics, Nevill Hall Hospital, Abergavenny, UK}

^{Department of Paediatrics, Gloucesteshire Royal Hospital, Gloucester, UK}

^{Dr Jasmin Ali,}moc.liamtoh@_ila_nimsaj

Accepted 2014 Mar 19.

Abstract

A previously well 11-month-old infant presented with lethargy, a blanching rash, vomiting and diarrhoea. She was diagnosed with suspected gastroenteritis and discharged. The patient deteriorated and re-presented 24 h later with lumbar puncture (LP) confirming Neisseria meningitidis. Following an initial good response to ceftriaxone, the patient then developed a blistering facial rash on day 3 for which topical aciclovir was started with no improvement. She subsequently developed fever and redeveloped a rising C reactive protein (CRP). A CT of the head on day 6 was normal, however a repeat LP on day 7 showed persistently raised cerebrospinal fluid (CSF), white cell count (WCC), high proteins and low CSF glucose. A CSF viral PCR confirmed concurrent herpes simplex virus (HSV) type 1 for which parenteral aciclovir was started. The patient responded well to bacterial and viral anti-infective treatments and was subsequently discharged on day 16 with no neurological sequelae.

Abstract

Learning points

Footnotes

Acknowledgement: The authors would like to thank Dr Marcus Pierrepoint.

Contributors: The four authors are justifiably credited with authorship, according to the authorship criteria. JA was responsible for the conception, design, drafting of the manuscript and literature search; HW was responsible for the drafting of the manuscript and corrections; SS was responsible for the conception and critical revision of the manuscript; NS was responsible for the conception and critical revision of the manuscript.

Competing interests: None.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

Footnotes

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