title: Concurrent meningococcal and herpes simplex infection in a non-immunocompromised child.
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.
authors.affiliation: Department of Paediatrics, Nevill Hall Hospital, Abergavenny, UK.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ali
authors.forename: Hannah
authors.initials: H
authors.lastname: Walsh
authors.forename: Swathi
authors.initials: S
authors.lastname: Sanapala
authors.forename: Nadeem
authors.initials: N
authors.lastname: Syed
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007121:Immunocompetence; D007223:Infant; D008585:Meningitis, Meningococcal / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008587:Meningitis, Viral / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009345:Neisseria meningitidis; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018139:Simplexvirus
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D002443:Ceftriaxone; D000212:Acyclovir