Recurrent bacterial meningitis by three different pathogens in an isolated asplenic child

Isolated congenital asplenia (ICA) is a rare condition at risk for overwhelming infection. When complicated by invasiveinfection, the mortality remains high, at greater than 60%. We describe a girl with ICA who developed recurrent meningitis bythree different pathogens. The first, meningitis by Escherichia coli, occurred 4 days after premature birth. The other twopathogens were serotype 6B Streptococcus pneumoniae and Haemophilus influenzae type b (Hib), at 18 and 25 months of age,respectively. The patient was successfully treated with prompt antimicrobial therapy in all episodes. Serumanti- polyribosylribitol phosphate (PRP) and anti-6B-type pneumococcal antibodies were below the levels for protectiveactivity after natural infections. Although anti-PRP antibody was significantly increased after Hib vaccination, two (6B and19F) of seven serotype-specific pneumococcal antibodies were not elevated to protective levels after the second 7-valentpneumococcal conjugate vaccine (PCV7). We, therefore, added a third PCV7. To our knowledge, this is the first neonatal ICApatient with invasive infection and the first case of bacterial meningitis occurring three times. Our findings indicate thatmonitoring of immune responses after natural infections and vaccinations, and reevaluations of vaccine schedule, areimportant for ICA patients to prevent subsequent invasive infections.