Meningitis associated with spinal anaesthesia: not always bacterial

ObjectiveWhen managing patients with acute meningitis in an emergency department (ED), early diagnosis of the type of infection (bacterial or viral) considerably affects the clinical course and treatment because of the high mortality and morbidity associated with bacterial meningitis (BM). The serum delta neutrophil index (DNI), a new inflammatory marker, reflects the fraction of circulating immature granulocytes and is elevated in cases of bacterial infection. The objective of this study was to evaluate whether serum DNI can be used to differentiate between BM and viral meningitis (VM) in the ED.MethodsThis retrospective, observational study included 104 consecutive patients (aged >18 years) diagnosed with acute meningitis from January 2012 to November 2014 in a regional emergency center. White blood cell and neutrophil counts, C-reactive protein level, and DNI were evaluated regarding their usefulness for differentiating BM and VM.ResultsSerum DNI was not significantly higher in the BM group (n=12) than in the VM group (n=92) (0 [interquartile range, 0% to 2.73%] vs. 0 [interquartile range, 0 to 0%], P=0.057). However, the white blood cell count and C-reactive protein level were statistically higher in the BM group (P=0.034 and P=0.026, respectively). Serum DNI was not found to be a statistically useful differential diagnostic parameter (area under the curve, 0.628; 95% confidence interval, 0.438 to 0.818).ConclusionCurrently, there is no evidence that the serum DNI aids in differentiating acute BM from acute VM in the ED.

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The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department

Lee

Park

Kim

et al. 2016

Clin Exp Emerg Med

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A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection

Kim¹,

Lee

Choi³

et al. 2014

J Neurocrit Care

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Background: Iatrogenic meningitis after spinal anesthesia is a rare condition. Most cases of iatrogenic meningitis have a bacterial etiology; however, there are a few reports of chemical meningitis associated with intrathecal administration of bupivacaine. Case Report: A 74-year-old man underwent cystoscopy, with anesthesia by intrathecal bupivacaine hydrochloride injection. Two hours post-procedurally, he complained of a severe headache and his mental status subsequently deteriorated from alertness to confusion. Cerebrospinal fluid examination on the day of admission showed an increase in cell count (841/mm 3 ; polymorphonuclear 78%: mononuclear 10%) and total protein (460 mg/dL). His clinical findings and laboratory abnormalities were consistent with the diagnosis of bupivacaine-induced chemical meningitis, rather than the bacterial meningitis. Conclusion: We report a case of chemical meningitis after spinal anesthesia with bupivacaine. Differential diagnosis should include chemical meningitis in cases of meningitis after spinal anesthesia.

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Meningitis associated with spinal anaesthesia: not always bacterial

Cited by 2 publications

References 6 publications

The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department

The usefulness of serum delta neutrophil index for differentiating bacterial and viral meningitis in the emergency department

A Case of Chemical Meningitis Induced by Intrathecal Bupivacaine Injection

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