660 RECURRENT PNEUMOCOCCAL MENINGITIS IN INFANTS UNDER OOU 15 MONTHS WITH SICKLE CELL DISEASE

Abstract

Children with sickle cell disease have a markedly increased susceptibility to pneumococcal septicemia and meningitis, attributed primarily to the loss of splenic function. Review of 24 cases of pneumococcal meningitis in sickle cell patients revealed a high frequency of recurrence chiefly among those infants whose initial episode of pneumococcal meningitis occurred before the age of 15 months. Twelve of 24 patients (50%) were under the age of 15 months; eight (33%) were below the age of 12 months (5,6, 6½,8,9,11,12, and 12 months) at the time of initial episode of meningitis. Five (20%) of 24 patients developed recurrent pneumococcal meningitis; four patients had one recurrence and one had three recurrences. All recurrences were seen in infants who were below the age of 15 months at the time of initial episode of meningitis. The interval between the initial episode and the recurrence ranged between one and 24 months. Evaluation of blood smear at the time of initial diagnosis of meningitis in 3/4 patients with recurrence revealed the presence of Howell-Jolly bodies (5,9, and 15 months)indicating splenic hypofunction. In this study pneumococcal meningitis in sickle cell patients occurred earlier than is generally reported and the recurrence rate was high when the initial episode was at less than 15 months, suggesting a defect in host defense in addition to the absence of splenic function in these very young patients. This suggests the need to evaluate antibody forming capacity in such infants.

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