Accuracy of clinical presentation for differentiating bacterial from viral meningitis in adults: a multivariate approach

Abstract

The presence of at least one sign of severity at referral and a CSF absolute neutrophil count above 1,000/mm3 mm are predictive of BM.

Identifying Low-risk Patients for Bacterial Meningitis in Adult Patients with Acute Meningitis

“…Several studies have developed clinical prediction models for differentiating BM from AM based on multivariable logistic regression modeling (17)(18)(19)(20)(21)(22). However, since physicians need to perform algebraic calculation at the bedside in order to apply these models, they are not eager to use these prediction rules (23).…”

Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome

“…Many features of our cohort were similar to those in previous studies of meningitis and a negative Gram stain: the predominance of young adults, clinical features, CSF findings, and the high proportion of hospitalization, cranial imaging, and empirical antibiotic use. [2][3][4][5][12][13][14][15][16] However, there were several noteworthy observations in our study. First, the differential diagnosis of the meningitis causes was broad, and because a large proportion of the patients were immunosuppressed, one of the most commonly recognized urgent treatable causes was C neoformans.…”

“…Other large studies that have included patients with meningitis and a negative Gram stain have focused on describing the clinical epidemiology or developing and validating models to differentiate viral vs bacterial meningitis but have not evaluated patient outcomes. 2,3,5,[12][13][14][15][16] In our study, 3 clinically cogent and easily obtainable baseline variables (age Ͼ60 years, a CSF glucose level Ͻ45 mg/ dL, and abnormal neurologic examination findings) were used to derive and validate a model that classifies patients into low and high risk for an ACO. Our low- risk group had a 0.5% risk of an ACO and represented the majority of our cohort (64%).…”

How to differentiate bacterial from viral meningitis

“…The presence of at least one sign of severity was the only clinical, and CSF neutrophil counts higher than 100010 6 /l the only laboratory predictor of bacterial origin. In the study by Brivet et al [19] the hospital mortality decreased from 46% to 24% between the first and the second halves of the study period. Because the data were analyzed only for the whole period, it is not clear whether signs of severity were predictive in each period separately.…”

“…In the study by Durand et al [18] 28% had focal neurological deficits. In view of these frequent signs of bacterial origin in patients with meningitis, Brivet et al [19] analyzed the clinical value of signs of severity to differentiate bacterial from viral meningitis in a retrospective cohort study involving 140 adults with different causes of meningitis. They analyzed the role of the initial clinical presentation and the relative diagnositic value of CSF parameters.…”