Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis

Lin, Wen-Li; Chi, Hsin; Huang, Fu‐Yuan; Huang, Daniel Tsung-Ning; Chiu, Nan-Chang

doi:10.1016/j.jmii.2014.08.013

Cited by 27 publications

(28 citation statements)

References 26 publications

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“…In this study, 135(68.9%) patients were investigated for their CSF, and among them, 84 (62.2%) of meningitis patients had an elevated level of WBC. Similar studies were done Felege Hiwot Referral Hospital [13], and in Taiwan [18] indicated that most admitted patients tested their CSF, which was about 69.8% and 88%, respectively. Among them, 98.3% and 83.8% had elevated WBC, respectively.…”

Section: Discussionsupporting

confidence: 72%

Clinical Outcome of Meningitis and Its Risk Factors Among Children Admitted in Debre Markos Referral Hospital Pediatric Ward, Northwest Ethiopia,2019

Meheretu

Shiferaw

Tafere

2020

Preprint

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Background:Meningitis remains a major cause of mortality and morbidity in patients in many countries of the world including Ethiopia. This study aimed to assess clinical outcomes and associated risk factors of meningitis among children who were admitted to Debre Markos Referral Hospital from January 2017 to December 2018.A backward stepwise multivariable logistic regression was applied with 95% confidence interval of odds ratio (OR) andstatistical significance less than 0.05 p-value were taken as cut off value.Methods:A retrospective cross-sectional study was conducted. The study includesAll pediatric meningitis 211 cases from the age of one month to fourteen who were admitted due to meningitis in Debre Markos Referral Hospitalfrom January 2017 to December 2018.Data were entered, cleaned, and analyzed using SPSS for Windows, version 20.Results:The study showed that 18.9% of children with meningitis developed bad outcomes. In this study, children who were a worse clinical condition at admission 6 times more likely to develop bad outcomes [AOR= 6.321(2.121, 18.837)] and having a seizure at admission almost 19 times more likely to develop bad outcomes [AOR=18.953(6.677, 53.799)]. Conclusions:About one in five children with meningitis developed bad outcomes. The health care team should due attention to improving care for patients with severe conditions at admission and seizures were the alarming signs for poor outcomes in children.

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Section: Discussionsupporting

confidence: 72%

Clinical Outcome of Meningitis and Its Risk Factors Among Children Admitted in Debre Markos Referral Hospital Pediatric Ward, Northwest Ethiopia,2019

Meheretu

Shiferaw

Tafere

2020

Preprint

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“…This appears to be the largest study evaluating the frequency, clinical characteristics, and outcomes of patients without CSF pleocytosis in five types of CNS infection. Previous studies have described case series of patients without CSF pleocytosis in relation to bacterial meningitis, herpes simplex encephalitis, and enteroviral meningitis (Saraya et al, 2016;Hui Tan et al, 2016;Lin et al, 2016). The lack of CSF pleocytosis in bacterial meningitis is rare, but this can be seen more commonly in viral infections.…”

Section: Discussionmentioning

confidence: 99%

“…Patients without CSF pleocytosis appeared to have a high rate of unfavorable outcomes, including sequelae and death. A recent study of 175 children with bacterial meningitis (Lin et al, 2016) identified the lack of CSF pleocytosis as a prognostic factor in the multivariable analysis. The examining clinician should not underestimate the presence of a CNS infection despite the lack of CSF pleocytosis for a patient with a suspicion of meningitis or encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system infections in the absence of cerebrospinal fluid pleocytosis

Erdem

Öztürk-Engin

Çağ

et al. 2017

International Journal of Infectious Diseases

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Previous multicenter/multinational studies were evaluated to determine the frequency of the absence of cerebrospinal fluid pleocytosis in patients with central nervous system infections, as well as the clinical impact of this condition. It was found that 18% of neurosyphilis, 7.9% of herpetic meningoencephalitis, 3% of tuberculous meningitis, 1.7% of Brucella meningitis, and 0.2% of pneumococcal meningitis cases did not display cerebrospinal fluid pleocytosis. Most patients were not immunosuppressed. Patients without pleocytosis had a high rate of unfavorable outcomes and thus this condition should not be underestimated.

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“…However, these parameters are often misleading, with an absence of pleocytosis (1-12% of cases) or predominant mononuclear cells (Bratlid and Bovre, 1977;Koutroumanidis et al, 2000;Hase et al, 2014). In one study, out of 645 patients with bacterial meningitis 7% of patients did not have pleocytosis (van de Beek et al, 2004;Lin et al, 2014;Mentis et al, 2016). Furthermore, these two parameters have low discriminatory power between bacterial versus viral meningitis.…”

Section: Quantitative Csf Analysis: Cells and Chemistrymentioning

confidence: 99%

CSF in acute and chronic infectious diseases

Benninger

Steiner

2018

Handbook of Clinical Neurology

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Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections. ACUTE INFECTIOUS DISEASES OF THE NERVOUS SYSTEMAcute infections of the nervous system are as diverse in their clinical consequences for the patient as the variety of infectious agents causing them: from mild headaches to long-term morbidity and a threat to life. Therefore, the earliest possible diagnosis is absolutely essential. Central here stands the examination of the CSF. The correct diagnosis is often dependent on this rather simple procedure to allow diagnosis and focused antimicrobial and adjunctive therapy. This chapter deals with acute infectious diseases of the nervous system and the importance of the lumbar puncture (LP) in the diagnostic process.

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Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis

Abstract: In children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis.

Cited by 27 publications

References 26 publications

Clinical Outcome of Meningitis and Its Risk Factors Among Children Admitted in Debre Markos Referral Hospital Pediatric Ward, Northwest Ethiopia,2019

Clinical Outcome of Meningitis and Its Risk Factors Among Children Admitted in Debre Markos Referral Hospital Pediatric Ward, Northwest Ethiopia,2019

Central nervous system infections in the absence of cerebrospinal fluid pleocytosis

CSF in acute and chronic infectious diseases

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