Infants With Meningitis Without Cerebrospinal Fluid Pleocytosis

Sir.—We recently cared for two infants with clinical signs of meningitis without cerebrospinal fluid (CSF) pleocytosis. However, cultures were positive within 24 hours forHaemophilus influenzaein one infant and β-hemolyticStreptococcusgroup 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.—Patient1.—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