MENINGOCOCCAL MENINGITIS WITH NORMAL CEREBROSPINAL-FLUID

A prospective study was made of all patients with normal CSF counts an d positive cultures for Neisseria meningitidis diagnosed in ''El Valle s'' County, Barcelona between January 1987 and December 1990. Meningoc occal meningitis was documented in 82 patients, eight of whom (seven c hildren, five boys and two girls with a mean age of 5.6 +/- 3.3 years, and a 69-year-old male patient) had no apparent CSF abnormalities in the initial lumbar puncture. At the time of admission all patients had fever (mean 39.1 degrees C) of 10.8 +/- 5.6 hour duration and petechi al rash which had been present for a mean of 3.6 +/- 3.3 hours. Signs of meningeal irritation were not found. A 4-month-old infant with symp toms of circulatory collapse, intracranial hypertension and impairment of consciousness subsequently died of septicemia in 48 hours. Group B N. meningitidis was isolated in six cases (reduced penicillin-suscept ibility in two cases) and group C N. meningitidis in the remaining two (reduced penicillin-susceptibility in one case). Patients without ple ocytosis did not differ in a statistically significant fashion from th e patients with high pleocytosis in the duration of temperature, and p etechial rash, leukopenia, positive blood culture and fatal outcome.