—The case reported by Dr Whelan of meningococcemia with an acellular CSF that showed growth of N meningitidis is certainly relevant to our series of bacterial meningitis in the absence of CSF pleocytosis. Although his case would not have fulfilled the strictest criteria for inclusion in our series (because there was no clinical, laboratory, or pathologic evidence of meningitis besides the positive results of the CSF and blood cultures), it seems likely that meningitis was developing in his patient.
We found no such patient in our series of adults, but did find a 7-year-old child with meningococcemia and a normal CSF positive for N meningitidis on culture in our series of children (D.B.F. and K.M.R., unpublished data).
Others have found this phenomenon with N meningitidis in children.1 All of these patients had clinical evidence of meningococcemia, meningitis, or both. Swartz and Dodge2 had one patient with N
Fishbein DB, Porter KM. CSF Pleocytosis-Reply. Arch Intern Med. 1982;142(3):643-644. doi:10.1001/archinte.1982.00340160223042