HPI: A 19-month-old child is brought to the emergency

department (ED) following a seizure. His mother says that he had a cold for 2-3 days with a cough, congestion, and low-grade fever, but today he became much worse. He has been fussy and inconsolable. He would not eat and slept most of the morning, followed by 2 grand-mal seizures. He has no history of seizures in the past. His mother reports that he has not received all of his immunizations. She is not sure which ones he has had, but he has only had 2 or 3 shots in his life.

PE: WD WN WM appearing very ill & lethargic

T = 100.5°F (38.1°C), P = 110 bpm

Neuro: does not respond to voice, but withdraws his extremities from painful stimuli.

Neck: grimaces when you try to bend his neck

Skin: without rash

HEENT = head, eyes, ear, nose, and throat examination WNL.

Cardiovascular, lung, and abdominal examinations are all WNL.

LAB:

White blood cell count (WBC) is elevated >10,000.

CT = computed tomography of his head is normal.

You perform a lumbar puncture (LP), which reveals numerous small G- coccobacilli.

Summary: A 19-month-old boy who has not received many immunizations presents with meningitis. The LP shows multiple G- coccobacilli.

Definitions

Epiglottitis: Inflammation of the epiglottis usually caused by Haemophilus influenzae, which presents as sore throat, fever, and difficulty breathing

Meningitis: Inflammation of the meninges leads to headache, stiff neck, and fever with increase in cells in the cerebrospinal fluid

Grand Mal Seizure: Seizure that results in loss of consciousness and generalized muscle contractions; tonic-clonic; a generalized seizure that affects the entire brain.

IUTD: Immunizations Up to Date

Discussion Questions

1. What organism is the most likely etiology of this illness?

2. What component of this organism is the target of vaccine-induced immunity?

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