Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children

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.

Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis

“…The CSF WBC count was significantly higher in bacterial meningitis (mean = 4839 cell/μL), compared with viral meningitis (mean = 159 cell/μL) ( P < .001) in a research and at the cutoff value of 321 WBC cell/μL the sensitivity and specificity for bacterial meningitis were 80.6% and 81.4%, respectively. [ 50 ] In the present study, the mean values of WBC count of CSF in bacterial meningitis and viral/aseptic meningitis patients were 3143 and 539 cell/μL, respectively and with NPV of 91.3% and PPV of 37%, this showed a high sensitivity and low specificity (Table 4 ).…”

Recombinant Neisseria surface protein A is a potential vaccine candidate against Neisseria meningitides serogroup B

“…Neisseria meningitidis, the pathogen of epidemic cerebrospinal meningitis, induces permanent damage to the brain and nervous system (1,2). This pathogen is also responsible for the development of invasive diseases caused by N. meningitidis, including septicemia, pneumonia and arthritis (3)(4)(5). Epidemic cerebrospinal meningitis has become a major public health problem, and developing novel methods to effectively control and prevent it has attracted worldwide attention.…”

Epidemiology of Different Types of Meningitis Cases in Gaza Governorates, Occupied Palestinian Territory, December 2013- January 2014

“…Other study found that CSF WBC count was significantly higher in patients with bacterial meningitis compared to patients with aseptic meningitis. The study concluded that a cutoff value of 321 CSF WBC count was found to be a useful and rapid diagnostic test to distinguish between bacterial and non-bacterial meningitis in children [13].…”