Editor—A 20 day old baby boy was referred to our hospital with a history of right sided facial palsy, nystagmus, and seizures. He had been born by normal vaginal delivery, at 36 weeks of gestation, with good Apgar score (8 and 9 at five minutes, respectively). He had jaundice, for which he required phototherapy for four days at the referring hospital, but was otherwise normal.

Ten days after discharge he presented again with a history of poor feeding and lethargy for one day. On examination, he looked pale with a full and tense anterior fontanelle. He was febrile and tachypnoeic. A presumptive diagnosis of sepsis/meningitis was made and he was given cefotaxime and ampicillin. Spinal …