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

Tokuda, Yasuharu; Koizumi, Masahiro; Stein, Gerald H.; Birrer, Richard B.

doi:10.2169/internalmedicine.48.1832

Cited by 14 publications

(7 citation statements)

References 30 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, numerous researchers have investigated potential clinical decision rules that recognize ABM from pAVM including: Thome [9], Spanos [10], Hoen [11] (also called Jaeger et al [12]), Freedman [13], Nigrovic [14], Oostenbrink [15], Bonsu 2004 [16], Brivet [17], Schmidt [18], De Cauwer [19], Chavanet [20], Dubos [21], Bonsu 2008[22], Tokuda [23], and Lussiana [24]. A few rules have included complicated multivariate models that require the use of a computer [10], [11], while others have used scoring systems [9], [15], tree model decisions [23], or a simple list of items [13], [14], [17], [18], [19], [20], [21], [22]. These clinical decision rules require extensive test prior to their use in hospitals [25] and have rarely been compared in a single study.…”

Section: Introductionmentioning

confidence: 99%

“…These clinical decision rules require extensive test prior to their use in hospitals [25] and have rarely been compared in a single study. In addition, several rules are yet to be tested by independent researchers [17], [21], [22], [23], [24] or tested in children [17], [23]. The Nigrovic's rule, also called Bacterial Meningitis Score (BMS) [14], performed perfectly in several studies [8], [26], [27], [28], [29], [30], but failed to provide 100% sensitivity in other independent data sets [7], [19], [20], [31].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Performance of Thirteen Clinical Rules to Distinguish Bacterial and Presumed Viral Meningitis in Vietnamese Children

et al. 2012

View full text Add to dashboard Cite

Background and PurposeSuccessful outcomes from bacterial meningitis require rapid antibiotic treatment; however, unnecessary treatment of viral meningitis may lead to increased toxicities and expense. Thus, improved diagnostics are required to maximize treatment and minimize side effects and cost. Thirteen clinical decision rules have been reported to identify bacterial from viral meningitis. However, few rules have been tested and compared in a single study, while several rules are yet to be tested by independent researchers or in pediatric populations. Thus, simultaneous test and comparison of these rules are required to enable clinicians to select an optimal diagnostic rule for bacterial meningitis in settings and populations similar to ours.MethodsA retrospective cross-sectional study was conducted at the Infectious Department of Pediatric Hospital Number 1, Ho Chi Minh City, Vietnam. The performance of the clinical rules was evaluated by area under a receiver operating characteristic curve (ROC-AUC) using the method of DeLong and McNemar test for specificity comparison.ResultsOur study included 129 patients, of whom 80 had bacterial meningitis and 49 had presumed viral meningitis. Spanos's rule had the highest AUC at 0.938 but was not significantly greater than other rules. No rule provided 100% sensitivity with a specificity higher than 50%. Based on our calculation of theoretical sensitivity and specificity, we suggest that a perfect rule requires at least four independent variables that posses both sensitivity and specificity higher than 85–90%.ConclusionsNo clinical decision rules provided an acceptable specificity (>50%) with 100% sensitivity when applying our data set in children. More studies in Vietnam and developing countries are required to develop and/or validate clinical rules and more very good biomarkers are required to develop such a perfect rule.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Performance of Thirteen Clinical Rules to Distinguish Bacterial and Presumed Viral Meningitis in Vietnamese Children

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The strategy was based on a simple score, the BM-CASCO, calculated from a set of five parameters derived from the initial clinical chemistry workup that were chosen by a review of the literature (5)(6)(7)9). Although previous scoring systems have been proposed to distinguish bacterial from viral meningitis (12)(13)(14)(15)(16), to the best of our knowledge, this is the first scoring system based only on clinical chemistry data for triage of suspected cases of ABM in adults to be subjected to further microbiological analysis of CSF. As a matter of fact, differently from other scores (14-16), neither microbiological (e.g., CSF Gram stain) nor clinical rules were taken into account.…”

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

View full text Add to dashboard Cite

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...

show abstract

“…The decrease in the CSF-blood glucose ratio that was observed in the present patient is atypical for aseptic meningitis (14). However, the CSF-blood glucose ratio is often low in aseptic meningitis, which makes it difficult to differentiate aseptic meningitis from other types of meningitis, including bacterial, tuberculous and fungal meningitis (15,16).…”

Section: Discussionmentioning

confidence: 99%

Lymphocytic Hypophysitis Accompanied by Aseptic Meningitis Mimics Subacute Meningoencephalitis

et al. 2011

View full text Add to dashboard Cite

A 66-year-old man was admitted to our hospital with muscle pain, fatigue and appetite loss that had lasted for a month. The patient was somnolent and had nuchal stiffness with a high fever. Cerebrospinal fluid (CSF) tests demonstrated lymphocytic pleocytosis with a decreased CSF-blood glucose ratio. The tests for tuberculous, fungal and carcinomatous meningitis and herpetic meningoencephalitis were negative. Endocrinological exams showed hypopituitarism and diabetes insipidus. A pituitary MRI showed an enlargement of the pituitary stalk. A diagnosis of lymphocytic hypophysitis with aseptic meningitis was made after the exclusion of secondary hypophysitis. Lymphocytic hypophysitis with aseptic meningitis can mimic subacute meningoencephalitis.

show abstract

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

Cited by 14 publications

References 30 publications

Performance of Thirteen Clinical Rules to Distinguish Bacterial and Presumed Viral Meningitis in Vietnamese Children

Performance of Thirteen Clinical Rules to Distinguish Bacterial and Presumed Viral Meningitis in Vietnamese Children

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

Lymphocytic Hypophysitis Accompanied by Aseptic Meningitis Mimics Subacute Meningoencephalitis

Contact Info

Product

Resources

About