Bacterial meningitis presenting with a normal cerebrospinal fluid leukocyte count

Soest, Thijs M. van; Chekrouni, Nora; Sorge, Nina M. van; Brouwer, Matthijs C.; Beek, Diederik van de

doi:10.1016/j.jinf.2022.02.029

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…From previous research we know that bacterial meningitis with a normal CSF leukocyte count upon presentation occurs in approximately 2% of cases. 33 However, in our cohort there were no bacterial meningitis cases with a normal CSF leukocyte count, making it impossible to assess the performance of cytokines in this population, where it could be especially useful. Lastly, the reference standard is a clinical diagnosis based on all available information, and it could be that certain episodes are misclassified by the clinician.…”

Section: Discussionmentioning

confidence: 81%

Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections

Olie,

Staal,

ter Horst

et al. 2024

Journal of Infection

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Section: Discussionmentioning

confidence: 81%

Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections

Olie,

Staal,

ter Horst

et al. 2024

Journal of Infection

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“…Among the 790 CABM children in the etiology-confirmed group, 32 cases (4.3%) had the normal first CSF leukocyte count (including 15 neonates), which was higher than foreign results. 41 Previous studies have suggested that the normal first CSF leukocyte count of CABM children was associated with a too-short time between CABM symptoms and first LP, antibiotics therapy, compromised immune function, and severity of disease. 42 Once CABM is highly suspected clinically, for children with the normal first CSF leukocyte counts, considering that it takes time for the immune response to CSF leukocyte infiltration following pathogens infection, we need to consider further CSF molecular biology assays to increase the positive detection rate of pathogens, and the appropriate antimicrobial treatment in combination with the patient’s age, risk factors, the immune status, the severity of the disease, and local resistance rates of dominant pathogen as early as possible.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019–2020

Wang,

Xu,

Liu

et al. 2023

IDR

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Objective To explore the epidemiological and pathogenic characteristics of children with community-acquired bacterial meningitis. Methods A multicenter, retrospective study was conducted among CABM patients under 15 years old from 33 hospitals in China from 2019 to 2020. The medical record, laboratory, and microbiological data were collected and analyzed. Results A total of 1610 children with CABM were identified and presented at a median onset age of 45 days of whom 955 (59.3%) were males. CABM occurred mostly in infants <1 year of age (84.0%, 1352/1610). In etiology-confirmed cases, the pathogens were isolated from CSF culture in 515 (32.0%), 400 (24.8%) in blood culture, and 186 (11.6%) both in CSF and blood culture. In total, 126 pathogens were identified through CSF mNGS in 330 CABM cases; 21 S. pneumoniae isolates were detected in 83 CABM cases by antigen detection method. Major pathogens were E. coli (195, 24.7%), GBS (170, 21.5%), and S. pneumoniae (157, 19.9%). GBS (29.3%, 22/75) was the first pathogen of CABM in neonates aged 0–6 days old, while E. coli (44.7%, 76/170) in 7 to 28 days of age; S. pneumoniae (96.2%, 151/157) was the most common pathogen in >3 months old cases. About 9.7% (19/195) strains of E. coli produced ultra‑broad‑spectrum β ‑lactamases. The common intracranial imaging complications were subdural effusion and (or) empyema in 349 (21.7%), hydrocephalus in 233 (14.5%), and cerebral abscess in 178 (11.1%). A total of 389 (24.2%) cases were completely cured and 1088 (67.6%) cases improved. Among 166 patients (10.3%) with adverse outcomes, 32 cases (2.0%) died, and 37 cases (2.3%) relapsed. Conclusion The onset age of CABM in children is usually within 1 year of age, especially <3 months. The primary pathogens in infants less than 3 months old are E. coli and GBS, and the dominant pathogen in children older than 3 months old is S. pneumoniae . Subdural effusion and (or) empyema and hydrocephalus are common complications. CABM should not be excluded even if CSF leukocyte counts are within normal range. Due to the low detection rate of pathogens in children with CABM, standardized CSF bacteriological examination should be paid more attention to increase the pathogen detection rate. Non‑culture CSF detection methods may facilitate pathogenic diagnosis.

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“…Similarly, McCreery et al showed an effective and safe reduction of the ME panel use in non-immunocompromised adults with CSF leukocytes count <10 ×10 6 /l ( 24 ). Due to the reported ( 26 ) possibility of bacterial meningitis with normal cerebrospinal fluid leukocytes counts and presence of severely immunocompromised patients in our analysis, protein concentration in cerebrospinal fluid was included in our criteria. When applying this rule in our population we found that not a single bacterial infection would have been missed.…”

Section: Discussionmentioning

confidence: 99%

Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

Erba,

Franzeck,

Hinic

et al. 2024

Front. Med.

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BackgroundThe Biofire® FilmArray® Meningitis/Encephalitis (ME) PCR panel covers 14 viral, bacterial, and fungal pathogens and has been implemented in many institutions worldwide. Post-marketing studies indicate a reduced sensitivity and overutilization underscoring the need for a more targeted usage. The aim of our study is to describe the utilization of the ME panel and to develop a diagnostic-stewardship based decision rule.MaterialsAdult patients, who underwent CSF analysis with the ME panel between August 2016 and June 2021 at the University Hospital Basel, were included. Demographic, clinical, microbiological, and laboratory data were extracted from the electronic health record. Factors associated with a positive ME panel result were identified, and a decision rule was developed to potentially optimize the diagnostic yield and reduce the number of unnecessary tests.Results1,236 adult patients received at least one panel in the observed period, of whom 106 panels tested positive (8.6%). The most frequently observed pathogens were Varicella Zoster Virus (VZV, 27%), Streptococcus pneumoniae (19%), Enterovirus (16%), Herpes simplex Virus 1/2 (16%), and Human Herpesvirus 6 (HHV-6, 13%). Fever, vomiting, headache, and photophobia were more frequently present in test positive patients as were significantly higher CSF leukocytes and protein concentrations. When simulating a decision rule based on CSF leukocytes and protein concentration, only 35% of all patients would have qualified for a ME panel tests, thereby increasing the positivity rate to 22.7%. 10 of 106 positive ME panels would have been missed, only involving HHV-6 and VZV (6 and 4 cases, respectively). As these subjects were either severely immunocompromised or had clinical features of shingles we propose extending the testing algorithm by including those criteria.ConclusionThe ME panel positivity rate at our institution was similar as previously published. Our results highlight the need for diagnostic-stewardship interventions when utilizing this assay by implementing a stepwise approach based on a limited number of clinical and laboratory features. This decision rule may improve the pretest probability of a positive test result, increase the quality of test utilization, and reduce costs.

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Bacterial meningitis presenting with a normal cerebrospinal fluid leukocyte count

Cited by 12 publications

References 29 publications

Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections

Diagnostic accuracy of inflammatory markers in adults with suspected central nervous system infections

A Multicenter Epidemiological and Pathogenic Characteristics Study of Community-Acquired Bacterial Meningitis Children in China: Results from the Chinese Pediatric Bacterial Meningitis Surveillance (CPBMS) 2019–2020

Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule

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