NEWS & EVENTS
Case of the Month - October 2010
Moherndran Archary, Ashendri Pillay, Raziya Bobat
Paediatric Infectious Disease Unit, Department of Paediatrics and Child Health University of KwaZulu Natal
In July 2010, a 6 year old HIV positive male child on HAART since June 2008 with immune restoration, presented to an emergency paediatric unit in Durban, with fever & headache of 1 week duration.
His immunisations were complete according to the South African vaccination schedule prior to 2009. He resides in
KwaZulu Natal with his grandmother under poor social circumstances.
No prior history of head trauma or rhinorrhoea was noted
On examination he was pyrexial with a temperature of 38oC.
CNS examination revealed photophobia and neck stiffness with positive Brudzinski & Kernig signs. He had a normal level of consciousness.
A mildly inflamed left tympanic membrane was noted on ENT examination.
A primary diagnosis of meningitis was made & the relevant investigations carried out:
His full blood count revealed a WCC of 25 x 109/L, platelets 341 x 109/L, Hb 13 g/dL, a normal U&E and a mildly elevated globulin level of 43g/L on his liver function tests
HIV viral Load was undetectable & his CD4 was 308 cells/mL
Gram positive cocci on CSF
Gram positive cocci on blood culture (figure 1)
Streptococcus pneumoniae identified on blood & CSF cultures
Both sensitive to Ceftriaxone
Figure 1. Blood culture showing Gram positive Streptococci
Further history revealed that it was his 5th admission for Streptococcus pneumonia meningitis.
Summary of Previous Admissions
CSF cultures +ve
Blood cultures -ve
CSF culture +ve serotype 19
Blood cultures -ve
CSF culture +ve
Blood culture +ve serotype 6A
CSF culture +ve serotype 23
Blood culture -ve
He had completed a full course of antibiotics with repeat CSF prior to discharge showing resolution of meningitis.
Figure A: X-ray sinuses showing right sinusitis
Figure B: CT Scan Mastoids confirming left mastoiditis
- HIV infection with immune restoration on HAART
- Recurrent S. pneumoniae meningitis secondary to:
- Chronic Mastoiditis
- Previous Head injury with intracranial communication
- Secondary immunodeficiency related to HIV
- Primary immunodeficiency syndrome
Question 1: What are the most common Streptococcus pneumoniae Serotypes causing invasive disease in children under 5 years in South Africa?Continue to Answer 1