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—The case reported by Dr Whelan of meningococcemia with an acellular CSF that showed growth of N meningitidis is certainly relevant to our series of bacterial meningitis in the absence of CSF pleocytosis. Although his case would not have fulfilled the strictest criteria for inclusion in our series (because there was no clinical, laboratory, or pathologic evidence of meningitis besides the positive results of the CSF and blood cultures), it seems likely that meningitis was developing in his patient. We found no such patient in our series of adults, but did find a 7-year-old child with meningococcemia and a normal CSF positive for N meningitidis on culture in our series of children (D.B.F. and K.M.R., unpublished data). Others have found this phenomenon with N meningitidis in children. 1 All of these patients had clinical evidence of meningococcemia, meningitis, or both. Swartz and Dodge 2 had one patient with N

To the Editor.— Riccardi and Felman stated that confirmation of N gonorrhoeae is necessary only in oral infections. However, several publications (242:1653, 1979) 1-4 show that N meningitidis has been isolated from sites other than the more common nasopharyngeal area. Therefore, limiting confirmation of the Neisseria sp to those isolated in the oral cavity would preclude the possibility of the identification of the meningococci from the atypical sites.

Neisseria lactamica was recovered from the blood and cerebrospinal fluid of a 7-month-old girl with acute purulent meningitis. The isolate was identified initially as N meningitidis. However, additional biochemical testing at the Center for Disease Control showed that the organism fermented lactose and produced beta-D-galactosidase, thereby confirming its identity as N lactamica.

The minor serogroups of Neisseria meningitidis (X,Y, and Z-W135 and 29 E) were initially considered to be of low virulence and were thought to produce very mild clinical disease. However, since 1974, many reports have appeared in the literature that clearly document that severe meningococcal disease does occur with group Y and group W135. 1-7 To our knowledge, there have been no previous reports of severe meningococcal disease in children caused by serogroups X or Z. We report two such cases. One case is that of severe meningococcemia and meningitis with disseminated intravascular coagulation (DIC) caused by group X N meningitidis and one is that of fatal fulminant meningococcemia and meningitis with DIC caused by group Z N meningitidis . Report of Cases .—Case1.—A 9-month-old infant was well until one day prior to admission, when she experienced fever, vomiting, and a rash. The child was seen at a local

The presence of Neisseria meningitidis in the vagina has not been well documented. This is probably due to the rare occurrence of this organism in this anatomic site. Neisseria meningitidis , when present in humans, can usually be recovered from the blood, cerebrospinal fluid, the nasopharynx, and petechiae of the skin. 1,2 Murray 3 reported the isolation of this organism from the male urogenital tract in 1939. The present recovery of N meningitidis represents, in addition to a rare isolate, the possibility that the meningococcus was the etiologic agent in a case of vaginitis. Meningococci may be recovered from man in the absence of disease but have been proven to be responsible for serious illnesses such as meningococcal meningitis, bacterial endocarditis, and meningococcemia, to name a few. The association of this organism with vaginitis had not been reported. Report of a Case A 5-year-old Negro girl was brought by her mother

It is a pleasure to review a book of such true excellence. Blair, Lennette, and Truant are to be congratulated for a superb job of assembling material covering the identification and isolation of bacteria, fungi, parasites, and viruses in a single volume. Usually manuals of this type are of interest only to the clinical laboratory worker. In this instance I feel this volume is a "must" for any internist whose subspecialty interest is infectious diseases. Large medical centers have microbiology laboratories staffed by well-trained individuals whose primary interest is clinical microbiology. But some hospital laboratories may not have kept abreast of the great progress that has occurred in the last decade. Improvements in transportation of specimens, isolation of Neisseria gonorrheae and N meningitidis , and identification of members of the family Enterobacteriaceae are examples. Consultation with this manual will allow the internist to review his hospital's microbiological methods with authority. One