![]() Throughout this paper, several abbreviations are used, which include: AIDS - Acquired Immune Deficiency Syndrome CSF - cerebrospinal fluid LP - lumbar puncture PCR - polymerase chain reaction WBC - white blood cell Χ 2- chi-square. There are no conflicts of interest in this report. The purpose of this paper is to review the published literature to describe themes associated with CSF culture-proven meningitis or CSF PCR positive in the absence of pleocytosis on initial LP. However, there are reports of PCR/culture-proven meningitis in the absence of elevated WBC on CSF analysis (pleocytosis). Timelier diagnostic clues of meningitis on CSF analysis include an elevated white blood cell (WBC) count or protein concentration, and decreased glucose concentration relative to blood. Definitive diagnosis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) in viruses obtained from a lumbar puncture (LP), which may take days. ![]() Meningitis is a serious acute infection of the meninges that can be caused by bacteria, viruses, parasites, or fungi. If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If this occurs, causative organism is likely bacterial. Meningitis in the absence of pleocytosis on CSF is rare. In addition to bacteremia, concomitant sources of infection occurred in 17 cases. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. Outcome was reported in 86 cases, 27 of which died and 59 survived. Causative organisms were primarily bacterial (99 cases). ResultsĪ total of 124 cases from 51 articles were included. ![]() Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Further, there is little available literature on the subject. However, meningitis may occur in the absence of pleocytosis on CSF.Īreas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. This could mean that previous low dosage antibiotic treatment should not modify CSF findings enough not to make correct diagnosis.Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. In 4 patients with positive cultures and little changes in CSF on admission, LP after 48 hours of correct treatment showed an increase in the alterations of CSF. In the other two there were pathological changes in CSF even with correct dosage of previous antibiotics. In 7 out of 102 no more than two CSF pathological findings were present. ![]() A decrease of the percentage PMN/lymphocytes was found in the CSF of the partially treated group. There were no significant differences in the levels of CSF glucose, proteins and WBC's between both groups. Previous treatment made culture of CSF negative in a statistically significant (p less than 0.001) number of cases, mainly in meningococcal meningitis. 46 of the patients (45%) had been treated previously with one or more antibiotics. Review of 102 admissions of children (one month to seven years of age) with bacterial meningitis is presented.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |