Sensitivity and specificity of meningeal signs in patients with meningitis

Akaishi, Tetsuya; Kobayashi, Junpei; Abe, Michiaki; Ishizawa, Kota; Nakashima, Ichiro; Akiyama, Masashi; Ishii, Tadashi

doi:10.1002/jgf2.268

Cited by 17 publications

(12 citation statements)

References 22 publications

(24 reference statements)

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“…So, the sensitivity of signs of meningeal irritation in Scrub typhus meningo-encephalitis was low in contrast to previous studies done in patients of bacterial meningitis, where it was 46.1% for neck rigidity and 22.9% for Kernig's sign. [ 16 ] In our study, lumbar puncture was performed in 16 cases. The findings of Cerebrospinal fluid (CSF) analysis is summarized in Table 3 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Verma

Gupta

Arya

et al. 2021

J Family Med Prim Care

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Background: Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients. Methods: This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests. Results: We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%). Conclusion: Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.

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Section: Discussionmentioning

confidence: 99%

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Verma

Gupta

Arya

et al. 2021

J Family Med Prim Care

View full text Add to dashboard Cite

show abstract

“…should be used during clinical examination. The nuchal rigidity and jolt accentuation are suggested to have higher sensitivity, while Kernig's sign and Brudzinski's signs have higher specificity [3].…”

Section: Discussionmentioning

confidence: 94%

“…In general, the most common symptoms of meningitis are fever, headache, photophobia, nausea, and vomiting [2]. Typical meningeal signs -nuchal rigidity, Kernig's sign, and Brudzinski's sign -are observed only in approximately half of the patients [3]. Differential diagnosis should include diseases associated with increased intracranial pressure and meningeal irritation, such as trauma, intracranial haemorrhage, or neoplastic disorders [4].…”

Section: Introductionmentioning

confidence: 99%

Difficulties in the diagnosis of meningitis – a challenging case of a child with head injury

Gregorczyk¹,

Stachurski²

2022

J Pre Clin Clin Res.

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Meningitis is a potentially life-threatening condition. The clinical manifestation can vary depending on the age of the child. This report presents the case of a 7-year-old male patient who was admitted to ED due to loss of consciousness after a head injury. Upon admission, the patient had seizures. Head CT scan did not show any signs of intracerebral bleeding or cerebral oedema. During hospitalization in the ICU, the patient began to be febrile and inflammatory markers started to rise. Treatment with antibiotics and antiviral agents was administered. Later, meningeal signs were observed. Additional imaging tests revealed ambiguous findings. The patient's symptoms resolved gradually, and he was discharged after 19 days of hospitalization. The final diagnosis was meningitis. This case highlights that the diagnosis of meningitis requires careful investigation and precise examination. This diagnosis should therefore be considered in all patients who present with symptoms concerning for meningitis.

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“…However, even in patients with unimpaired consciousness, the sensitivity of many clinical tests such as testing for meningism is well below 100%. A recent meta-analysis reported a sensitivity of 46.1% for nuchal rigidity in patients with suspected meningitis [22]. A Cochrane review indicated a sensitivity of 75.5% for the jolt accentuation of headache, which decreased to 65.3% when patients with impaired consciousness were included [23].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of the neurological examination in coma of unknown etiology

et al. 2021

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Background Identifying the cause of non-traumatic coma in the emergency department is challenging. The clinical neurological examination is the most readily available tool to detect focal neurological deficits as indicators for cerebral causes of coma. Previously proposed clinical pathways have granted the interpretation of clinical findings a pivotal role in the diagnostic work-up. We aimed to identify the actual diagnostic reliability of the neurological examination with regard to identifying acute brain damage. Methods Eight hundred and fifty-three patients with coma of unknown etiology (CUE) were examined neurologically in the emergency department following a predefined routine. Coma-explaining pathologies were identified retrospectively and grouped into primary brain pathology with proof of acute brain damage and other causes without proof of acute structural pathology. Sensitivity, specificity and percentage of correct predictions of different examination protocols were calculated using contingency tables and binary logistic regression models. Results The full neurological examination was 74% sensitive and 60% specific to detect acute structural brain damage underlying CUE. Sensitivity and specificity were higher in non-sedated patients (87/61%) compared to sedated patients (64%/59%). A shortened four-item examination protocol focusing on pupils, gaze and pyramidal tract signs was only slightly less sensitive (67%) and more specific (65%). Conclusions Due to limited diagnostic reliability of the physical examination, the absence of focal neurological signs in acutely comatose patients should not defer from a complete work-up including brain imaging. In an emergency, a concise neurological examination should thus serve as one part of a multimodal diagnostic approach to CUE.

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Sensitivity and specificity of meningeal signs in patients with meningitis

Cited by 17 publications

References 22 publications

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India

Difficulties in the diagnosis of meningitis – a challenging case of a child with head injury

The diagnostic value of the neurological examination in coma of unknown etiology

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