title: Recurrent bacterial meningitis by three different pathogens in an isolated asplenic child.
abstract: Isolated congenital asplenia (ICA) is a rare condition at risk for overwhelming infection. When complicated by invasive infection, the mortality remains high, at greater than 60%. We describe a girl with ICA who developed recurrent meningitis by three different pathogens. The first, meningitis by Escherichia coli, occurred 4 days after premature birth. The other two pathogens were serotype 6B Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), at 18 and 25 months of age, respectively. The patient was successfully treated with prompt antimicrobial therapy in all episodes. Serum anti-polyribosylribitol phosphate (PRP) and anti-6B-type pneumococcal antibodies were below the levels for protective activity after natural infections. Although anti-PRP antibody was significantly increased after Hib vaccination, two (6B and 19F) of seven serotype-specific pneumococcal antibodies were not elevated to protective levels after the second 7-valent pneumococcal conjugate vaccine (PCV7). We, therefore, added a third PCV7. To our knowledge, this is the first neonatal ICA patient with invasive infection and the first case of bacterial meningitis occurring three times. Our findings indicate that monitoring of immune responses after natural infections and vaccinations, and reevaluations of vaccine schedule, are important for ICA patients to prevent subsequent invasive infections.
authors.affiliation: Department of Pediatrics, Nishi-Kobe Medical Center, 5-7-1 Kojidai, Nishi-ku, Kobe, 651-2273, Japan. s00-081@nms.ac.jp
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Uchida
authors.forename: Kousaku
authors.initials: K
authors.lastname: Matsubara
authors.forename: Tamaki
authors.initials: T
authors.lastname: Wada
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oishi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morio
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Takada
authors.forename: Aya
authors.initials: A
authors.lastname: Iwata
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yura
authors.forename: Katsunori
authors.initials: K
authors.lastname: Kamimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nigami
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukaya
mesh_terms: D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000276:immunology; D002675:Child, Preschool; D004927:Escherichia coli Infections / Q000276:immunology / Q000382:microbiology; D005260:Female; D006192:Haemophilus Infections / Q000276:immunology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000276:immunology / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000276:immunology / Q000382:microbiology; D012008:Recurrence; D013154:Spleen / Q000002:abnormalities*
chemical_list: D001428:Bacterial Vaccines