A 4 month-old white female infant was admitted to Munson Medical Center with meningitis.

Four or five days prior to admission she had developed a low-grade fever without accompanying symptoms. Initially she seemed to improve but a couple days later developed higher fevers (101 to 103°) with fussiness but no cough, runny nose, etc. Subsequently she developed loose stools, vomiting, and lethargy. The day prior to admission she was seen in an urgent care facility where it was thought that she might have an ear infection. She was prescribed amoxicillin and ear drops.

When seen by her pediatrician the following day she appeared lethargic and dehydrated. Her mother described having observed her infant's eyes "to roll back". On examination the child's temperature was 99.3°, her neck was supple, and although she appeared to have dry mucous membranes, her anterior fontanelle was bulging. She had no rash.

Laboratory data included WBC 12.1, Hbg 9.6, and Plts 343. A lumbar puncture revealed these results: WBC 3250 (96% segmented neutrophils), glucose <3 mg/dl, and protein 197. CSF gram stain is at left.

The infant had been previously healthy. She had received immunizations according to schedule including initial Haemophilus influenza type B and pneumococcal conjugate vaccines at age 2 mos.