Meningococcal meningitis with ‘normal’ cerebrospinal fluid

Coll, Maria-Teresa; Uriz, María-Socorro; Pineda, Valentı́; Fontanals, Dionísia; Bella, Feliu; Nava, J. M.; Deulofeu, Francesc; Morera, Maria-Antònia; Martí, Carme; Lite, Josep; Garau, Javier; Font, Bernat

doi:10.1016/s0163-4453(94)91197-5

Cited by 57 publications

(30 citation statements)

References 10 publications

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“…[17,18] There have been documented cases of bacterial meningitis in the absence of pleocytosis, with a particular occurrence in children. [19,20] Normal CSF meningitis may occur when underlying immunosuppressive states are present; however, this acellular phenomenon is exceptionally rare in an immunocompetent adult. [15,21] We have noted only eight similar cases of acellular pneumococcal meningitis in the literature.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenges with acellular bacterial meningitis

Moolla

Naidoo

2016

S Afr Med J

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Section: Discussionmentioning

confidence: 99%

Diagnostic challenges with acellular bacterial meningitis

Moolla

Naidoo

2016

S Afr Med J

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“…Bacterial meningitis is diagnosed in a patient with clinical evidence of meningeal irritation and inflammatory response to infection in the CSF [26]. However, confirmation of the clinical diagnosis may sometimes be difficult as bacterial meningitis with normal CSF has been reported by several authors [25,26,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…However, confirmation of the clinical diagnosis may sometimes be difficult as bacterial meningitis with normal CSF has been reported by several authors [25,26,28,29]. Since, at the time of hospital admission, the clinical manifestations of patient 2 were considered to be suggestive of meningococcal infection, he received early treatment with antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Two family members with a syndrome of headache and rash caused by human parvovirus B19

Pereira¹,

Barros²,

Nascimento³

et al. 2001

Braz J Infect Dis

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Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

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“…Lumbar punctures were performed on suspect meningitis cases, and CSF specimens were submitted for laboratory analysis. A confirmed diagnosis of meningitis due to N. meningitidis or S. pneumoniae required a positive test result from the CSF in at least one of the following assays: Gram stain, culture, or a pathogen-specific PCR assay [20][21].…”

Section: Methodsmentioning

confidence: 99%

A duplex real-time PCR for the detection of Streptococcus pneumoniae and Neisseria meningitidis in cerebrospinal fluid

Diawara

Katfy

Zerouali

et al. 2016

J Infect Dev Ctries

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Introduction: Acute bacterial meningitis is one of the most severe infectious diseases. Rapid, accurate, and inexpensive diagnosis of bacterial meningitis is crucial for patient management. This study describes a duplex real-time (RT) PCR assay for detection of Neisseria meningitidis and Streptococcus pneumoniae in the cerebrospinal fluid (CSF) for meningitis diagnosis using SYBR Green-based RT-PCR method coupled with melting curve analysis. Methodology: We used SYBR Green-based RT-PCR method coupled with melting curve analysis to detect S. pneumoniae and N. meningitidis in CSF samples. The sensitivity, specificity, and limit of detection were determined. The gold standard for routine tests of CSF analysis is direct examination, culture, and/or latex agglutination. The assay was evaluated on 132 CSF samples to measure clinical sensitivity. Results: A duplex RT-PCR assay for N. meningitidis and S. pneumoniae detection in CSF was evaluated. Two peaks at different melting temperatures (87.5°C and 85.5°C) for N. meningitidis and S. pneumoniae, respectively, were obtained. The sensitivity of RT-PCR was 100% (95% confidence limits [CI] = 82.4-100) for N. meningitidis and 100% (95% CI = 85.1-100) for S. pneumoniae. Specificity was the same (100%) for the bacteria (95% CI = 88.6-100). The percentage of cases accurately diagnosed with meningitis caused by N. meningitidis and S. pneumoniae increased to 50.7% and 28.6%, respectively, when RT-PCR was added to the standard microbiologic methods. Conclusions: Duplex RT-PCR and melting curve analysis with SYBR Green is an inexpensive, sensitive, and specific method to rapidly diagnose bacterial meningitis. Accurate identification of the bacterial causative agents will improve patient management and epidemiological investigations.

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Meningococcal meningitis with ‘normal’ cerebrospinal fluid

Cited by 57 publications

References 10 publications

Diagnostic challenges with acellular bacterial meningitis

Diagnostic challenges with acellular bacterial meningitis

Two family members with a syndrome of headache and rash caused by human parvovirus B19

A duplex real-time PCR for the detection of Streptococcus pneumoniae and Neisseria meningitidis in cerebrospinal fluid

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