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Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children.
Braz J Infect Dis. 2013 Jul-Aug; 17(4):401-4.BJ

Abstract

Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell≥7μL(-1)) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0±4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningitidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839cells/μL) compared to patients with aseptic meningitis (mean, 159cells/μL, p<0.001), with those with aseptic meningitis (mean, 577cells/μL, p<0.001) and with all non-bacterial meningitis cases together (p<0.001). A cutoff value of 321white blood cell/μL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children.

Authors+Show Affiliations

Department of Pediatrics, Centro Hospitalar São João, EPE, Porto, Portugal. sofiamsa@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23602468

Citation

Águeda, Sofia, et al. "Prediction of Bacterial Meningitis Based On Cerebrospinal Fluid Pleocytosis in Children." The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, vol. 17, no. 4, 2013, pp. 401-4.
Águeda S, Campos T, Maia A. Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. Braz J Infect Dis. 2013;17(4):401-4.
Águeda, S., Campos, T., & Maia, A. (2013). Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases, 17(4), 401-4. https://doi.org/10.1016/j.bjid.2012.12.002
Águeda S, Campos T, Maia A. Prediction of Bacterial Meningitis Based On Cerebrospinal Fluid Pleocytosis in Children. Braz J Infect Dis. 2013 Jul-Aug;17(4):401-4. PubMed PMID: 23602468.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children. AU - Águeda,Sofia, AU - Campos,Teresa, AU - Maia,Ana, Y1 - 2013/04/18/ PY - 2012/09/22/received PY - 2012/12/10/accepted PY - 2013/4/23/entrez PY - 2013/4/23/pubmed PY - 2014/1/28/medline KW - Bacterial meningitis KW - Cutoff point KW - Pleocytosis SP - 401 EP - 4 JF - The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases JO - Braz J Infect Dis VL - 17 IS - 4 N2 - Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell≥7μL(-1)) was conducted. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0±4.3 years distributed as: 12.2% 1-3 months; 10.5% 3-12 months; 29.8% 12 months to 5 years; 47.5% >5 years. Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. Bacterial meningitis was caused by Neisseria meningitidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839cells/μL) compared to patients with aseptic meningitis (mean, 159cells/μL, p<0.001), with those with aseptic meningitis (mean, 577cells/μL, p<0.001) and with all non-bacterial meningitis cases together (p<0.001). A cutoff value of 321white blood cell/μL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children. SN - 1678-4391 UR - https://www.unboundmedicine.com/medline/citation/23602468/Prediction_of_bacterial_meningitis_based_on_cerebrospinal_fluid_pleocytosis_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1413-8670(13)00062-7 DB - PRIME DP - Unbound Medicine ER -