Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

Dubos, François; Korczowski, Bartosz; Aygün, Denizmen; Martinot, A.; Prat, Cristina; Galetto-Lacour, Annick; Casado‐Flores, Juan; Taşkın, Erdal; Leclerc, F.; Corrêa-Oliveira, Rodrigo; Gervaix, Alain; Gendrel, D.; Breart, Gérard; Chalumeau, Martin

doi:10.1136/adc.2010.186056

Cited by 75 publications

(57 citation statements)

References 18 publications

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“…17,18 Evidence from adult meningitis patients suggests that CSF lactate level and serum procalcitonin level would be better discriminative parameters for bacterial meningitis, however, the cost of both examinations limits their availability. 5,19,20 The current study concentrated on basic CSF and blood examinations that can be carried out in ordinary laboratories, even in laboratories in remote rural areas. The results showed that a low CSF WBC count with increased protein levels and/or decreased glucose levels correlated with poor outcomes of the pediatric patients with bacterial meningitis.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Chi

Huang

et al. 2016

Journal of Microbiology, Immunology and Infection

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Section: Discussionmentioning

confidence: 99%

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

Lin

Chi

Huang

et al. 2016

Journal of Microbiology, Immunology and Infection

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“…The diagnostic accuracy of this prediction model was confirmed in a retrospective validation study (n = 500) [8], but these authors proposed a new diagnostic model (AUC close to 1) based on four different independent variables (CSF protein, CSF PMN, blood glucose and blood WBC). These findings evoked the interest of other groups to validate the various diagnostic prediction models, and also to introduce new self-computed models that showed varying degrees of sensitivity (77%-98%) and specificity (49%-98%) for predicting bacterial meningitis in neonates, children and adults [9][10][11][12][13][14].…”

Section: Cerebrospinal Fluid (Csf)mentioning

confidence: 99%

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

Fleming

Russcher

Lindemans

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:In many inflammatory diseases, the cellular components in body fluids [cerebrospinal fluid (CSF), serous fluids] are increased, rendering essential diagnostic information. The diagnostic value of the total white blood cell count (WBC) and differential count has been evaluated extensively over the years, and a remarkable amount of knowledge has been gained; yet, there is a great deal of clinical uncertainty whether the diagnosis should be based solely on these variables. In some diseases, such as peritonitis, the total WBC and differential count has high sensitivity; whereas, in differentiating pleural effusions, it lacks the sensitivity required to be clinically useful. Nevertheless, many guidelines consider these tests as cornerstone parameters, and in combination with clinical variables, they can successfully guide clinical decision making in initiating or postponing a treatment course for infection and/or inflammatory diseases while awaiting culture results. Although other methods are available for detecting and differentiating WBCs in body fluids, manual microscopy is still considered the gold standard despite its many limitations. During the last decade, automated analyzers have become a popular method for first line screening. Continued progress in their design has led to major improvements including their speed, improved accuracy and lower variability compared with microscopy. Disadvantages of this method include high imprecision in low ranges (depending on the method) and interfering factors.In a time where automation is at the front line in clinical laboratories, it is essential the results obtained are precise, accurate and reproducible. This review provides an overview of the relevance for cell counting in a variety of diagnostic body fluids, and highlights the current technologies used.

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“…Bakteriyel ve aseptik menenjit ayrımında serum prokalsitonin düzeyinin ≥ 0,5 ng/mL, > 2 ng/mL, > 4,8 ng/mL, ≥ 5 pg/mL düzeylerindeki kesim noktalarındaki duyarlılığı %100-89 ve özgüllüğü %93,5-66 arasında değiştiği rapor edilmiştir (13)(14)(15)(16)(17). Bu çalışmaların bir kısmında prokalsitoninin, CRP ve tam kan sayımı parametrelerine göre bakteriyel menenjiti öngörmede daha duyarlı bir laboratuvar testi olduğu bildirilmiştir (14)(15)(16)(17).…”

Section: Discussionunclassified

THE EFFECTIVENESS OF LABORATORY TESTS FOR THE PREDICTION OF ACUTE BACTERIAL MENINGITIS IN THE PEDİATRİC EMERGENCY DEPARTMENT The Effectiveness of Laboratory Tests for the Prediction of Acute Bacterial Menengitis in the Pediatric Emergency Department

Gökalp¹,

Bal²,

Bıcılıoğlu³

et al. 2015

Turk J Ped Em Int Care Med

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ÖZET Amaç:Çocuk acil servisinde akut bakteriyel menenjit ön tanısıyla lomber ponksiyon yapılan çocuklarda laboratuvar tetkiklerinin tanıdaki yerinin araştırılması. Yöntemler: 01.01.2008 -31.12.2013 yılları arasında İzmir Tepecik Eğitim ve Araştırma Hastanesi Çocuk Acil Servisi'nde akut bakteriyel menenjit ön tanısıyla lomber ponksiyon yapılan çocukların tıbbi kayıtları geriye dönük olarak incelenmiştir. Başvuru öncesi antibiyotik kullanan olgular çalışma dışı bırakılmıştır. Olgular 3 grup altında toplanmıştır: Normal beyin omurilik sıvısı (BOS), aseptik menenjit ve akut bakteriyel menenjit. Bu üç grubun laboratuvar tetkikleri karşılaştırılmıştır. Bulgular: Toplam 632 olgu (ortalama yaş: 42,2 ± 0,8 ay; minimum: 1 ay; maksimum: 210 ay; 387 erkek) çalışmaya dahil edildi. Toplam 205 olguda (%32,4) normal BOS bulguları, 401 olguda (%63,4) aseptik menenjit ve 29 olguda (%4,6) akut bakteriyel menenjit saptandı. Akut bakteriyel menenjit grubunda serum prokalsitonin düzeyi yüksek ve BOS glikoz düzeyi düşük saptandı (p < 0,05). Serum prokalsitoninin (< 24 ng/mL) ve BOS glikozunun (< 49 mg/dL) duyarlılık-ları %95 ve %51,8; özgüllükleri %92 ve %70,6 olarak saptandı. Periferik kandaki lökosit ve nötro l sayıları, serum Creaktif protein düzeyi, BOS lökosit sayısı ve protein düzeyleri açısından gruplar arasında fark saptanmadı (p > 0,05). Sonuç: Acil serviste lomber ponksiyon yapılan çocuk olguların çok az bir kısmında akut bakteriyel menenjit saptanmıştır. Serum prokalsitonin ölçümü çocuk acil servisinde akut bakteriyel menenjiti ayırt etmede etkin bir laboratuvar testi olarak öne çıkmıştır. CAYD 2015;2(1):19-24. Anah tar Ke li me ler: Menenjit, prokalsitonin, BOS glikoz, Çocuk AcilTo evaluate the accuracy of laboratory tests in identifying children who had lumbar puncture for suspected bacterial meningitis in the ED. Methods: Retrospective review of the medical records of children with preliminary diagnosis of acute bacterial meningitis and had a lumbar puncture between January 1st, 2008 and December 31st, 2013. All patients presenting to the emergency department (ED) of Izmir Training and Research hospital during the study period. Children who received antibiotics prior to admission to the ED were excluded. The patient population was strati ed into three group based on the results of cerebrospinal analysis and culture (CSF); normal, aseptic meningitis, and bacterial meningitis. The results of all laboratory tests were compared between the groups. Results: We enrolled 632 patients. The mean age was 42.2 ± 0.8 month (range 1-210 months) and 387 were males. Normal CSF was noted in 205 patients (32.4%), aseptic meningitis 401 patients (63.4%), and 29 (4.6%) had bacterial meningitis. Children with acute bacterial meningitis had a higher level of procalcitonin and lower levels of CSF glucose

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Distinguishing between bacterial and aseptic meningitis in children: European comparison of two clinical decision rules

Cited by 75 publications

References 18 publications

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

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

Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease

THE EFFECTIVENESS OF LABORATORY TESTS FOR THE PREDICTION OF ACUTE BACTERIAL MENINGITIS IN THE PEDİATRİC EMERGENCY DEPARTMENT The Effectiveness of Laboratory Tests for the Prediction of Acute Bacterial Menengitis in the Pediatric Emergency Department

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