The treatment of Streptococcus pneumoniae meningitis can be complicated by prolonged or secondary fevers. Prolonged fever is the term used to describe a fever in excess of 10 days' duration after initiation of treatment, while a secondary fever is a temperature elevation usually greater than 38°C following at least 1 afebrile day after the primary fever. Although prolonged and secondary fevers are not a new problem, the increasing antibiotic resistance of S pneumoniae and the use of steroid therapy in meningitis has complicated the issue. Two patients with S pneumoniae meningitis with secondary fever lasting more than 10 days were seen at our medical center recently, and issues in their management prompted this discussion.
Secondary and prolonged fevers can occasionally be explained by intercurrent infection, phlebitis, or drug reactions.1-4 Frequently the fevers are attributed to a complication of the primary infection, such as subdural effusion or empyema,1,2 although