Combined forms of meningitis: Mixed infection of the meninges by the tubercle bacillus and meningococcus

Abstract

It is rare to find two different causative organisms in a case of meningitis and of extreme rarity when one of these organisms is the tubercle bacillus. Neal (1924) reported her analysis of 1535 cases of meningitis, in which only six (0-32 per cent.) were due to mixed-organisms. All six cases were in children and included such organisms as the meningococcus, staphylococcus, b. paratyphosus B., haemolytic and non-haemolytic streptococcus, pneumococcus, and organisms of the b. coli group, but not the tubercle bacillus. An interesting case of mixed meningitis was described by Ravitch and Washington (1937) in a child whose blood culture grew meningococci and salmonella suipestifer. Both organisms were also cultured from the cerebrospinal fluid, but it was believed that the salmonella suipestifer had been introduced by blood contamination of the cerebrospinal fluid during lumbar puncture. Ashmun (1933) had five cases of mixed meningitis with pneumococci and streptococci present in the cerebrospinal fluid of all cases. In two cases the diplococcus catarrhalis was also present.