Clinical decision rules for acute bacterial meningitis: current insights

Abstract

Acute community-acquired bacterial meningitis (BM) requires rapid diagnosis so that suitable treatment can be instituted within 60 minutes of admitting the patient. The cornerstone of diagnostic examination is lumbar puncture, which enables microbiological analysis and determination of the cerebrospinal fluid (CSF) cytochemical characteristics. However, microbiological testing is not sufficiently sensitive to rule out this diagnosis. With regard to the analysis of standard CSF cytochemical characteristics (polymorphonuclear count, CSF glucose and protein concentration, and CSF:serum glucose), this is often misleading. Indeed, the relatively imprecise nature of the cutoff values for these BM diagnosis markers can make their interpretation difficult. However, there are two markers that appear to be more efficient than the standard ones: CSF lactate and serum procalcitonin levels. Scores and predictive models are also available; however, they only define a clinical probability, and in addition, their use calls for prior validation on the population in which they are used. In this article, we review current methods of BM diagnosis.

Infectious Complications of Expanded Endoscopic Transsphenoidal Surgery: A Retrospective Cohort Analysis of 100 Cases

“…50 Serum procalcitonin levels and CSF lactate also have been reported to be reliable for the diagnosis of meningitis. [50][51][52] Pagliano et al 32 defined meningitis after EETS identical to our criterion and identified Streptococcus, Staphylococcus, and Haemophilus species. Out of the 28 cases in the review, only one case each of Candida albicans and Enterococcus species were reported.…”

Diagnostic Approach to Health Care- and Device-Associated Central Nervous System Infections

“…The conventional clinical signs and symptoms of community-acquired CNS infection are insensitive and unreliable in patients with recent neurosurgery or a CNS device. The classic meningitis triad of fever, neck stiffness, and altered mental status or headache has a sensitivity of just 40% to 50% for health care-associated CNS infections and manifests fully in a minority of cases (24). A large retrospective study highlighted the poor sensitivity of clinical signs and symptoms for VAI, with less than half of patients having headache (48.5%), fever (40.5%), altered mental status (40.6%), nausea or vomiting (39.5%), or photophobia (6.5%) (21).…”

Pharmacologic Treatment of Meningitis and Encephalitis in Adult Patients

“…CSF lactate as well as CSF and serum procalcitonin levels both hold promise as additional tools to aid in the differentiation between bacterial and viral meningitis, although sensitivity and specificity vary widely between studies. [8][9][10] While a lumbar puncture is most likely to accurately identify the causative organism if performed prior to antibiotic administration, delivering antibiotics should not be delayed for the procedure. Even though the ability to culture bacteria from the CSF drops after administration of antibiotics, the sample will often still show a CSF profile consistent with bacterial meningitis (neutrophilic pleocytosis with high white cell count, low glucose, elevated protein, and elevated opening pressure), thus assisting in diagnosis.…”