Sir.—We recently cared for two infants with clinical signs of meningitis without cerebrospinal fluid (CSF) pleocytosis. However, cultures were positive within 24 hours for Haemophilus influenzae in one infant and β-hemolytic Streptococcus group B in the other. We report these cases to warn physicians that meningitis may occur in the absence of CSF pleocytosis, even in otherwise healthy and normal children.
Patient Reports.—Patient 1.—An 8-month-old black male infant was in good health until three days prior to admission, when lethargy, decreased appetite, 38.4°C temperature, and "twitching movements" that lasted about ten minutes developed. The patient had nuchal rigidity, a grade 1/6 soft systolic murmur, and diffuse rales in both lung fields. Brudzinski's and Kernig's signs were negative. Results of admission laboratory tests, including a complete blood cell count, were normal. Hemoglobin electrophoresis showed hemoglobin A only. Serum immunoglobulins, total serum hemolytic complement, neutrophil chemotaxis, and chemoluminescence were