CASE 11
Mary is 20 months of age and has been hospitalized with a fever, irritability, and moderate dehydration. Blood work suggests a bacterial infection, with elevated neutrophils (>96%; normal: ˜70%), although the chest radiograph and urinalysis are normal. Computed tomography (CT) indicated intracranial evidence for generalized edema with some compression of the ventricles. Despite the risk associated with elevated cerebrospinal fluid (CSF) pressure, a lumbar puncture was performed that showed an elevated white cell count. An analysis of the CSF by polymerase chain reaction (PCR) assay revealed the presence of Neisseria meningitidis. Mary has been receiving intravenous antibiotics for 30 hours, and there is some improvement in her condition. Query into the child’s background indicated that Mary had been breast fed until she was 3 months of age and had been relatively healthy until this recent infection. Detailed family history reveals that a distant male cousin and an aunt both died at an early age (<2 years) of meningitis. What further tests might you order? What is the significance of the history and findings?
