The Bacterial Meningitis Score to Distinguish Bacterial From Aseptic Meningitis in Children From Sao Paulo, Brazil

Filho, Eduardo Mekitarian; Horita, Sergio Massaru; Gilio, Alfredo Elias; Alves, Anna Cláudia Dominguez; Nigrovic, Lise E.

doi:10.1097/inf.0b013e3182913e84

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…In Brazil, Mekitarian Filho et al, 7 also found excellent sensitivity using BMS in children with meningitis treated at the Hospital Universitário da Universidade de São Paulo , São Paulo (SP), observing a sensitivity and a negative predictive value of 100% with the score. However, the number of Brazilian and international studies conducted in private hospitals is still scarce, and this may generate controversy over the data, due to the fact that, at private services, more exams are requested and the patients seek treatment soon.…”

Section: Discussionmentioning

confidence: 98%

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Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children

Pires

Franco

Gilio

et al. 2017

Einstein (São Paulo)

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Objective To measure the role of enterovirus detection in cerebrospinal fluid compared with the Bacterial Meningitis Score in children with meningitis.Methods A retrospective cohort based on analysis of medical records of pediatric patients diagnosed as meningitis, seen at a private and tertiary hospital in São Paulo, Brazil, between 2011 and 2014. Excluded were patients with critical illness, purpura, ventricular shunt or recent neurosurgery, immunosuppression, concomitant bacterial infection requiring parenteral antibiotic therapy, and those who received antibiotics 72 hours before lumbar puncture.Results The study included 503 patients. Sixty-four patients were excluded and 94 were not submitted to all tests for analysis. Of the remaining 345 patients, 7 were in the Bacterial Meningitis Group and 338 in the Aseptic Meningitis Group. There was no statistical difference between the groups. In the Bacterial Meningitis Score analysis, of the 338 patients with possible aseptic meningitis (negative cultures), 121 of them had one or more points in the Bacterial Meningitis Score, with sensitivity of 100%, specificity of 64.2%, and negative predictive value of 100%. Of the 121 patients with positive Bacterial Meningitis Score, 71% (86 patients) had a positive enterovirus detection in cerebrospinal fluid.Conclusion Enterovirus detection in cerebrospinal fluid was effective to differentiate bacterial from viral meningitis. When the test was analyzed together with the Bacterial Meningitis Score, specificity was higher when compared to Bacterial Meningitis Score alone.

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Section: Discussionmentioning

confidence: 98%

“…The sample size estimation was based on the specificity observed by Mekitarian Filho et al, 7 since a sensitivity of 100% was also required for this study. Assuming BMS has a 53% accuracy in the identification of children with aseptic meningitis (specificity), and an absolute accuracy of 5%, a sample of 383 cases of meningitis was estimated.…”

Section: Methodsmentioning

confidence: 99%

Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children

Pires

Franco

Gilio

et al. 2017

Einstein (São Paulo)

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“…However, two children (5% of children with bacterial meningitis) had CSF lactate below the cutoff point. Therefore, CSF lactate should not be used alone but rather combined with a validated clinical prediction model such as the Bacterial Meningitis Score [8-10]. Importantly, this prediction model appropriately identified both children with bacterial meningitis and CSF lactate <3.0 mmol/l.…”

Section: Discussionmentioning

confidence: 99%

“…The study was approved by the institutional review board. Details of the study protocol have been described previously [8]. We included children who had clinical findings consistent with meningitis (e.g., fever, headache, vomiting or nausea, and neck stiffness) along with CSF white blood cells (WBC) ≥10 cells/μl [corrected for the presence of CSF red blood cells (RBC) using a standard 1:500 ratio of leukocytes to erythrocytes] and who had both a CSF lactate and CSF culture obtained.…”

Section: Methodsmentioning

confidence: 99%

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Cerebrospinal fluid lactate level as a diagnostic biomarker for bacterial meningitis in children

et al. 2014

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BackgroundCerebrospinal fluid (CSF) lactate is a potential biomarker for bacterial meningitis in children. To this end, we performed a single-center retrospective cohort study of children from Sao Paulo, Brazil, with CSF pleocytosis to evaluate the ability of CSF lactate to distinguish between children with bacterial and aseptic meningitis. We determined the optimum cutoff point for CSF lactate using receiver-operator curve (ROC) analysis.FindingsWe identified 451 children of whom 40 (9%) had bacterial meningitis. Children with bacterial meningitis had a higher median CSF lactate level [9.6 mmol/l, interquartile range (IQR) 3.2-38.5 mmol/l bacterial meningitis vs. 2.0 mmol/l, IQR 1.2-2.8 mmol/l aseptic meningitis]. A CSF lactate cutoff point of 3.0 mmol/l had a sensitivity of 95% [95% confidence interval (CI) 83-99%), specificity of 94% (95% CI 90-96%) and negative predictive value of 99.3% (95% CI 97.7-99.9%) for bacterial meningitis.ConclusionsIn combination with a validated meningitis clinical prediction rule, the CSF lactate level can be used to distinguish between bacterial and aseptic meningitis in children with CSF pleocytosis.

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Validation of the bacterial meningitis score in adults presenting to the ED with meningitis

McArthur

Edlow

Nigrovic

2016

The American Journal of Emergency Medicine

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The Bacterial Meningitis Score to Distinguish Bacterial From Aseptic Meningitis in Children From Sao Paulo, Brazil

Cited by 7 publications

References 13 publications

Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children

Comparison of enterovirus detection in cerebrospinal fluid with Bacterial Meningitis Score in children

Cerebrospinal fluid lactate level as a diagnostic biomarker for bacterial meningitis in children

Validation of the bacterial meningitis score in adults presenting to the ED with meningitis

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