Meningitis in Children: Diagnosis and Treatment for the Emergency Clinician

Richard, Gabriella Cardone; Lepe, Marcos

doi:10.1016/j.cpem.2013.04.008

Cited by 6 publications

(8 citation statements)

References 76 publications

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“…Clinically, aseptic meningitis can be described as a meningitis-like syndrome in which cultures for routine bacterial pathogens are consistently negative (32). Although viral infections remain the most common cause, both infectious and noninfectious etiologies are frequently implicated, possibly related to local inflammatory reactions precipitated by blood breakdown products or neoplastic disease processes (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

“…Interesting, aseptic meningitis is thought to account for approximately 60-75% of all postoperative meningitis cases with patients often exhibiting favorable clinical outcomes (7). On the other hand, the mortality rate for bacterial meningitis regularly approaches 100%, carrying a significant risk of severe neurological sequelae (32,36). Until recently, fever and raised CSF polymorphonuclear WBCs provided the mainstay of investigations for differentiating between bacterial and aseptic meningitis in the acute setting (37).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis*

Liu

Chen

et al. 2015

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis*

Liu

Chen

et al. 2015

Critical Care Medicine

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“…In neonates, S. agalactiae and E. coli are the most common agents of meningitis in North America (11), Australasia (14), and Europe (15). The morbidity rate of neonatal meningitis is up to 56%; if not treated, the mortality can approach 100% (16). In rare situations, other bacterial pathogens can cause acute meningitis, including coagulase-negative staphylococci, Burkholderia pseudomallei, Pseudomonas aeruginosa, miscellaneous gram-negative bacilli, Staphylococcus aureus, viridans streptococci, and anaerobic bacteria.…”

Section: Bacterial Meningitismentioning

confidence: 99%

“…Most cases of community-acquired aseptic meningitis are the result of viruses. Aseptic meningitis is suspected when CSF cultures for routine bacteria are negative and there were no antibiotics given before the lumbar puncture (16).…”

Section: Viral Meningitismentioning

confidence: 99%

Infectious Meningitis

Zueter

Zaiter

2015

Clinical Microbiology Newsletter

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Infectious meningitis is a large public health concern, especially in children and immunocompromised patients. Although the epidemiology of meningitis has shown significant decline in past decades, partly due to the introduction of vaccines, outbreaks are still reported worldwide. Diagnosis of meningitis is of critical importance, and it is considered to be one of the most urgent of the microbiological medical emergencies. In order to improve the treatment strategy, various diagnostic methods have been developed to detect the presence of infectious agents that cause meningitis, as well as their antibiotic resistance patterns. This article aims to enhance the understanding of meningitis and to highlight the most current updates that describe outbreaks of meningitis and the subsequent investigations. We also describe the current diagnosis and treatment options. CMN

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“…Specifically, pleocytosis has shown predictive ability for bacterial meningitis (8). However, other studies suggest that pleocytosis as a diagnostic indicator for M/E is limited due to poor specificity and complicating factors such as numerous viral exceptions (9)(10)(11)(12). Overall, the literature on this topic is often conflicting and difficult to interpret.…”

mentioning

confidence: 99%

Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray Meningitis/Encephalitis Panel Utilization in Pediatric Patients

et al. 2020

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Molecular testing of cerebrospinal fluid (CSF) using the BioFire FilmArray meningitis/encephalitis (FA-M/E) panel permits rapid, simultaneous pathogen detection. Due to the broad spectrum of targeted organisms, FA-M/E testing may be restricted to patients with abnormal CSF findings. We sought to determine if restriction is appropriate in our previously healthy and/or immunocompromised pediatric patients. FA-M/E was ordered on 1,025 CSF samples from 948 patients; 121 (11.8%) specimens were FA-M/E positive. Of these, 89 (73.6%) were virus positive, and 30 (24.8%) were bacterium positive. The most common targets detected were enterovirus (n = 38), human herpesvirus 6 (HHV-6) (n = 30), and Streptococcus pneumoniae (n = 14). Pleocytosis with white blood cell (WBC) levels of ≥5 cells/mm3 and ≥10 cells/mm3 were found in 33.1% and 24.3% of all specimens, respectively. Using WBC levels of ≥5 cells/mm3, 63.4% (59/93) of positive specimens exhibited pleocytosis, compared to 29.5% (233/789) of negative specimens. Among positive specimens, 54.4% (37/68) of viral and 87% (20/23) of bacterial cases had pleocytosis. The use of a pleocytosis cutoff of ≥10 cells/mm3 would have missed an additional enterovirus, one cytomegalovirus (CMV), and two HHV-6 diagnoses. CSF glucose and protein levels were normal for 83/116 (75.2%) and 51/116 (44%) positive specimens. Abnormal glucose in combination with WBC levels of ≥10 cells/mm3 showed high specificity (94.5%) and was a better predictor of FA-M/E positivity than abnormal protein. Sensitivity and positive predictive values were <90% for all biomarkers. CSF pleocytosis and abnormal glucose/protein were poor predictors of FA-M/E. Restricting FA-M/E orders based on pleocytosis or other abnormal parameters would have resulted in missed diagnostic opportunities, particularly for the detection of viruses in both previously healthy and immunocompromised patients.

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Meningitis in Children: Diagnosis and Treatment for the Emergency Clinician

Cited by 6 publications

References 76 publications

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis*

Raised Proinflammatory Cytokine Production Within Cerebrospinal Fluid Precedes Fever Onset in Patients With Neurosurgery-Associated Bacterial Meningitis*

Infectious Meningitis

Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray Meningitis/Encephalitis Panel Utilization in Pediatric Patients

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