Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

Hase, Ryota; Hosokawa, Naoto; Yaegashi, Makito; Muranaka, Kiyoharu

doi:10.1155/2014/568169

Cited by 34 publications

(26 citation statements)

References 19 publications

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“…First, we should recall that pleocytosis is not equivalent to meningitis. Although most studies defined pleocytosis (more than 5 cells/µl) as the gold standard for meningitis, patients with human immunodeficiency virus (HIV) infection, cancer, or a splenectomy do not necessarily show pleocytosis even when they have bacterial meningitis . Moreover, bacterial meningitis cases with no abnormalities in initial CSF testing, which later demonstrated pleocytosis, have been reported .…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Does This Adult Patient With Jolt Accentuation of Headache Have Acute Meningitis?

et al. 2018

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JA is not a universal, stand-alone, indicator of meningitis in febrile patients with headache. Therefore, we propose a stepwise approach for patients with suspected acute meningitis. AMS or neurological deficits suggest an intracranial pathology, which may necessitate a lumbar puncture. JA seems a useful tool for distinguishing acute aseptic meningitis from upper respiratory infection when used in the selected cohort of febrile patients (≥37°C) with recent-onset headache (within 2 weeks before presentation) and normal mental status. This approach and diagnostic values of JA should be further investigated by prospective studies using operationally sorted candidates.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Does This Adult Patient With Jolt Accentuation of Headache Have Acute Meningitis?

et al. 2018

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“…The ED physicians, however, are aware that ABM cases with no abnormalities in the initial CSF testing are possible, although extremely rare, with specific clinical conditions (e.g., congenital or acquired immune deficiencies in host defense mechanisms, strong epidemiological context, neurosurgery, prior antibiotic therapy, etc.) (17)(18)(19)(20); they are allowed to override the new procedure and request further urgent microbiological analysis of CSF, irrespective of the BM-CASCO (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…However, considering that bacterial meningitis with no abnormalities in initial CSF testing is possible, although extremely rare, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately in the presence of any signs of sepsis or meningitis (7,(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults

Lagi

Bartalesi

Pecile³

et al. 2016

J Clin Microbiol

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Microbiological tests on cerebrospinal fluid (CSF) utilize a common urgent-care procedure that does not take into account the chemical and cytological characteristics of the CSF, resulting sometimes in an unnecessary use of human and diagnostic resources. The aim of this study was to retrospectively validate a simple scoring system (bacterial meningitis-Careggi score [BM-CASCO]) based on blood and CSF sample chemical/cytological parameters for evaluating the probability of acute bacterial meningitis (ABM) in adults. BM-CASCO (range, 0 to 6) was defined by the following parameters: CSF cell count, CSF protein levels, CSF lactate levels, CSF glucose-to-serum glucose ratio, and peripheral neutrophil count. BM-CASCO was retrospectively calculated for 784 cases of suspected ABM in adult subjects observed during a four-and-a-halfyear-period (2010 to 2014) at the emergency department (ED) of a large tertiary-care teaching hospital in Italy. Among the 28 confirmed ABM cases (3.5%), Streptococcus pneumoniae was the most frequent cause (16 cases). All ABM cases showed a BM-CASCO value of >3. Most negative cases (591/756) exhibited a BM-CASCO value of <1, which was adopted in our laboratory as a cutoff to not proceed with urgent microbiological analysis of CSF in cases of suspected ABM in adults. During a subsequent 1-year follow-up, the introduction of the BM-CASCO in the diagnostic workflow of ABM in adults resulted in a significant decrease in unnecessary microbiological analysis, with no false negatives. In conclusion, BM-CASCO appears to be an accurate and simple scoring system for optimization of the microbiological diagnostic workflow of ABM in adults. C ases of acute bacterial meningitis (ABM) require prompt diagnosis and treatment due to significant mortality rates (1, 2). A delay in starting appropriate therapy may worsen the prognosis (1). Recently, the epidemiology of ABM has shifted to older age groups due to the increasing child vaccination rates against the most common meningeal pathogens (3, 4). Streptococcus pneumoniae is currently the leading cause of ABM in adults and is associated with a 17 to 30% mortality rate (2-4).Diagnosis of ABM at the time of clinical presentation is often difficult and requires laboratory investigation of cerebrospinal fluid (CSF) specimens. A Gram stain of the CSF sediment is a widely used test for the rapid detection of bacteria but may suffer from low sensitivity (5). When evaluated on adult subjects not previously treated with antibiotics, the CSF Gram stain has been reported to have a sensitivity between 60% and 92% (6). Sensitivity can be increased by molecular tests, such as real-time PCR (RT-PCR), but these tests are still not widespread due to their high cost and the need for expensive equipment and experienced laboratory personnel. Bacterial culture remains the gold standard for microbiological diagnosis of ABM, but it requires longer times and suffers from reduced sensitivity in cases involving previous antimicrobial chemotherapy (6). In addition, biochemical and cyto...

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“…20 Bacterial meningitis due to L. monocytogenes is an important exception, with approximately 60% of cases having a leukocyte count of <1000 cells/μL, which may be lymphocytic. 24 In addition, 10% of cases have a lymphocytic predominance. 23 It is critical that these leukocyte ranges are not viewed as absolute cut-off values.…”

Section: Cell Counts and Chemistrymentioning

confidence: 99%

Meningitis in adults: diagnosis and management

Young

Thomas

2018

Internal Medicine Journal

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Bacterial meningitis is a medical emergency. All clinicians who provide acute medical care require a sound understanding of the priorities of managing a patient with suspected meningitis during the first hour. These include obtaining blood cultures, performing lumbar puncture and initiating appropriate therapy, while avoiding harmful delays such as those that result from not administering treatment until neuroimaging has been performed. Despite the increasing availability of newer diagnostic techniques, the interpretation of cerebrospinal fluid parameters remains a vital skill for clinicians. International and local guidelines differ with regard to initial empirical therapy of bacterial meningitis in adults; the North American guideline recommends ceftriaxone and vancomycin for all patients, while the Australian, UK and European guidelines recommend that vancomycin only be added for patients who are more likely to have pneumococcal meningitis or who have a higher likelihood of being infected with a strain of Streptococcus pneumoniae with reduced susceptibility to ceftriaxone. Patients with risk factors for Listeria meningitis also require an anti‐Listeria agent, such as benzylpenicillin, to be added to this treatment regimen. Dexamethasone should be a routine component of empirical therapy due to its proven role in reducing morbidity and mortality from pneumococcal meningitis.

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Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

Cited by 34 publications

References 19 publications

Does This Adult Patient With Jolt Accentuation of Headache Have Acute Meningitis?

Does This Adult Patient With Jolt Accentuation of Headache Have Acute Meningitis?

Proposal for a New Score-Based Approach To Improve Efficiency of Diagnostic Laboratory Workflow for Acute Bacterial Meningitis in Adults

Meningitis in adults: diagnosis and management

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