PEDIATRICS Vol. 80 No. 1 July 1987, pp. 63-67
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Neisseria meningitidis Bacteremia in Children: Quantitation of Bacteremia and Spontaneous Clinical Recovery Without Antibiotic Therapy

T. Dennis Sullivan MD1 and Leonard J. LaScolea Jr PhD1

1 From the Departments of Pediatrics and Microbiology, The State University of New York at Buffalo; and Divisions of Ambulatory Pediatrics and Infectious Diseases, The Children's Hospital of Buffalo, Buffalo New York

The relationship between the magnitude of bacteremia due to Neisseria meningitidis and the clinical diagnosis was determined for 43 children who had fever in the presence or absence of focal signs of infection. Bacteremia was quantitated by the previously described procedure using heparinized blood (0.2 to 1.0 mL). Additionally, blood was cultured by means of the radiometric Bactec technique. Seventeen patients had meningitis, 12 had meningococcemia, 13 had unsuspected or "occult" bacteremia, and five had other diagnoses. "Occult" bactermia was diagnosed initially in four patients, but subsequently meningitis was diagnosed. All 13 patients with 500 or more organisms per milliliter had meningitis or meningococcemia in contrast to 12 (55%) of 22 patients with less than 500 organisms per milliliter (P le .0035). Only 18 (42%) of these patients bacteremic with N meningitidis presented with petechiae or purpura. All 13 children with occult bacteremia were sent home after blood cultures were obtained; six of the 13 received a regimen of oral amoxicillin for otitis media. At reexamination (interval 16 to 119 hours) four had meningitis, seven were clinically improved (afebrile, negative blood culture, without invasive disease), and two were still mildly febrile with negative blood culture. Three of these bacteremic children experienced spontaneous clinical and bacteriologic resolution without antibiotic treatment. This has not been previously reported.

Key Words: Neisseria meningitidis • bacteremia • quantitative blood culture

Accepted on October 20, 1986




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