Meningitis in Cape Town children.

A prospective clinical and microbiological survey of 213 children who presented to the teaching hospitals of the Cape Peninsula with meningitis was performed during a winter month. The predominant bacterium isolated was Neisseria meningitidis and this survey uncovered an outbreak of viral meningitis due to echovirus 4 of the Du Toit strain. In comparison with previous studies, the absence of fever in 20% of the cases of meningococcal disease and the isolation of N. meningitidis group B organisms which were resistant to sulphonamides are noted. Cases of N. meningitidis meningitis with initial clinical and cerebrospinal fluid findings indistinguishable from those in echovirus 4 meningitis are presented to emphasize the difficulties encountered in making a differential diagnosis. We recommend that in endemic areas all children with meningitis should be observed in hospital for at least 48 hours until the diagnosis of N. meningitidis has been excluded bacteriologically.