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PubMed2002

Prevalence of fungal meningitis among HIV positive & negative subjects in Indore (MP state).

The aim of the study was to find out the prevalence of fungal meningitis among AIDS cases and to assess the prognosis of fungal meningitis among HIV positive & negative subjects. The study comprised of 15 & 10 cases of fungal meningitis among HIV positive & negative subjects respectively during the study period 1992-2001. India ink preparation and Gram's staining procedures were carried out on the centrifuged CSF deposits. The CSF deposits were also used for bacterial and fungal culture. In the present study the prevalence of fungal meningitis was noted among 15 (3.1%) of 483 AIDS cases. Twelve of them had cryptococcal meningitis while 3 were infected with Candida albicans. Four AIDS cases presented fungal meningitis as a primary opportunistic infection and HIV status was confirmed in 4 of them after the diagnosis of fungal meningitis. 13 of the 15 cases were in the age group 26-40 yrs while one was 55 yrs old and the other 16 month old child; these two cases had blood transfusion transmitted and vertically transmitted mode of HIV transmission respectively. Further, only two of 15 cases were females and both acquired HIV infection through blood transfusion. Overall prognosis of fungal meningitis was poor among HIV positives and 7 of the 15 cases died in hospital within 2-3 weeks after diagnosis of cryptococcal meningitis. Among HIV negative subjects, ten cases of fungal meningitis (3 with Candida albicans and 7 with Cryptococcous neoformans) were noted at our end and nine of them had immunocompromised status (3 cases of renal transplant on immunosuppressives, 3 cases neonates/infant and 2 diabetic subjects. The fungal meningitis is one of the important causes of morbidity & mortality among immunocompromised among HIV positive subjects.

AIDS-Related Opportunistic Infections↗
PubMed2004

Rapid diagnosis of meningitis using reagent strips.

OBJECTIVES: Identification of causative agent with estimation of cerebrospinal fluid (CSF) glucose, protein, cells is necessary for accurate diagnosis of meningitis. Unfortunately, even these facilities are not available in many areas. Reagent strips that measure glucose and protein in blood and urine can serve this task but have been used with varying results in the past. This study was carried out to evaluate the utility and efficacy of Combur 10 strips in the diagnosis of meningitis. DESIGN, SETTINGS AND METHODS: A prospective clinical single blinded study of 63 children suspected to have meningitis undergoing CSF analysis. Each CSF sample was divided in to two and was utilised for reagent strip analysis in addition to standard laboratory evaluation and a correlation analysis were made. STATISTICAL METHOD USED: Results were analysed using standard statistical tests. Accuracy of the reagent strips as a screening tool was established using Godyn's test. RESULTS: The sensitivity, specificity of the reagent strips for the diagnosis of meningitis was 97.14%, 96.42%. The sensitivity, specificity for tuberculous meningitis and bacterial meningitis were 100%, and 96.55%. That for the aseptic meningitis was 70% and 96.55%. Accuracy for the diagnosis of meningitis as a whole, bacterial meningitis, tuberculous meningitis, and aseptic meningitis were 96.78%, 98.2%, 98.27% and 83.0% respectively. CONCLUSION: Combur10 strips thus can be used for the rapid CSF analysis and screening with good accuracy. In situations where facilities of routine laboratory testing are not available this can be of an immense help.

Child, Preschool↗
PubMed1989

[Infectious meningitis in the adult: 3-year clinical experience].

In order to establish the epidemiologic features of infectious meningitis in the adult population in our environment, the experience of the Department of Neurology of the Hospital del Rey during the 3-year period, from 1984 to 1986, has been analyzed. Three-hundred-ninety episodes were handled, of which, 51% were acute bacterial meningitis, 45% were acute lymphocytic meningitis, 26% were tuberculous meningitis, 1% were brucellar meningitis and 0.5% were due to Candida albicans. Acute bacterial meningitis predominated in winter, whereas acute lymphocytic meningitis predominated in summer (p less than 0.001). Forty-seven percent of acute bacterial meningitis were due to Neisseria meningitidis and 14.5% of acute lymphocytic meningitis with virologic study, were due to Herpesviridae. The mortality rate of acute bacterial meningitis was 8.5% and that of tuberculous meningitis was 10%. In order to emphasize the importance of these processes, the main epidemiologic data are compared with that of other studies.

Adolescent↗
PubMedDate not supplied

[Neonatal bacterial meningitis in a tertiary treatment center].

OBJECTIVE: To determine incidence, etiologic agents and clinical manifestations of bacterial meningitis in patients hospitalized in the newborn ward at the Hospital Infantil de Mexico in Mexico City and establish the incidence of meningitis in newborns admitted with respiratory distress syndrome (RDS) and determine how often blood cultures are negative in bacterial meningitis in this population. METHODS: Retrospective chart review of patients with bacterial meningitis admitted to our hospital. STUDY PERIOD: January 1990-July 1995. RESULTS: There were 959 admissions to the neonatal intensive care unit (NICU). The overall incidence of bacterial meningitis was 32.3/1000 admissions; however, among 170 patients with RDS, [corrected] meningitis was detected in one (5.9/1000 RDS patients). Of the 31 patients with bacterial meningitis, 10 were preterm (PT) and 21 term (T). In the cerebrospinal fluid (CSF) isolates, there was a predominance of gram negative rods (n: 19; 61%). Clinical findings associated to meningitis were non-specific and there were no differences between PT and T infants. From 31 patients, 19 had negative blood cultures at the time of diagnosis (61%). Mortality associated to bacterial meningitis was [corrected] 40% and 23%, for PT and T, respectively (p = NS). CONCLUSIONS: The incidence of bacterial meningitis in the study population was high. Most isolates in CSF were gram-negative rods. Clinical findings in meningitis were non-specific and there were no differences between PT and T. Most of the patients (61%) had negative blood cultures at the time of diagnosis.

Bacteremia↗
PubMed2000

[Rapid diagnosis of the type of meningitis (bacterial or viral) by the assay of serum procalcitonin].

OBJECTIVE: It has been shown that serum procalcitonin (PCT) can be used to differentiate bacterial from viral meningitis in children in all cases. The aim of this study was to demonstrate the interest of PCT in the management of suspected meningitis in adults. PATIENTS AND METHODS: We conducted a prospective study including 179 consecutive patients admitted to the emergency department for suspected meningitis. All samples were taken at patient admission. The discriminant potential between bacterial and viral meningitis was studied for cerebrospinal fluid parameters (cytology, protein, glucose, lactate) and serum parameters (C reactive protein, PCT). RESULTS: Thirty-two patients had bacterial meningitis, 90 had viral meningitis and meningitis was ruled out in 57. Among all studied parameters, the most discriminant for distinguishing between bacterial and viral meningitis in 100% of the cases proved to be serum procalcitonin with a threshold value of 0.93 ng/ml. CONCLUSION: Serum procalcitonin is an interesting parameter in the emergency department for management of meningitis suspicion in adults.

Adenoviridae Infections↗
PubMed2006

Primary and opportunistic pathogens associated with meningitis in adults in Bangui, Central African Republic, in relation to human immunodeficiency virus serostatus.

OBJECTIVE: To determine the causative organisms and characteristics of patients presenting with meningitis in Bangui in order to provide guidance to physicians for case management. METHODS: Adults with proven or suspected meningitis were enrolled in this prospective study. LABORATORY TESTS: Full blood count, blood chemistry, and HIV tests were performed. Cerebrospinal fluid (CSF) was submitted for routine microbiology, chemistry (glucose, protein), and hematology testing. When classical microbiology analyses were negative, a broad-range bacterial polymerase chain reaction (BRBPCR) was used. RESULTS AND CONCLUSIONS: Of the 276 patients enrolled, 215 (77.9%) were HIV positive. In HIV-positive patients cryptococcal meningitis (CM) was the most common cause of meningitis (39.1%) followed by pyogenic meningitis (PM) (30.7%), mononuclear meningitis (MM) (28.8%), and tuberculous meningitis (TM) (1.4%). In HIV-negative patients, PM was the most common cause (60.7%) followed by MM (37.7%) and CM (1.6%, one case). In-hospital mortality was higher in HIV-positive patients (73/128 = 57%) compared to those HIV negative (3/18 = 16.7%) (p = 0.001). Streptococcus pneumoniae (n = 26) was the most common bacterial diagnosis, mainly in HIV-positive patients (n = 22, 10.2%). Meningococcal meningitis (14 Neisseria meningitidis of group A and one W135) was diagnosed in nine (4.2%) HIV-positive and six (9.8%) HIV-negative patients. Gram-negative rods were isolated from five HIV-positive and two HIV-negative patients, respectively. The bacteria and fungi involved in meningitis did not display high levels of in vitro resistance. Conventional microbiology techniques failed to detect the causative agent in 55 (53.4%) PM cases. Broad-range bacterial PCR detected DNA from S. pneumoniae in three samples, N. meningitidis in two, Escherichia coli in one, Listeria monocytogenes in two and Staphylococcus aureus in one sample. In the CSF of five (three HIV negative and two HIV positive), PCR products were not identified with the oligonucleotide probes specific for the usual species of bacteria found in CSF, or genera commonly considered potential contaminants of clinical samples. Among the MM cases, 77 (90.5%) probable viral meningitis (54 HIV positive and 23 HIV negative) and eight TM (HIV positive) were suspected.

Adolescent↗
PubMed2005

An audit of the investigation and initial management of adults presenting with possible bacterial meningitis.

OBJECTIVES: This study was carried out to determine local levels of compliance with guidelines from the British Infection Society (BIS) for the early management and investigation of adult patients presenting with possible bacterial meningitis [J Infect 39 (1999) 1; J Infect 46 (2003) 75]. METHODS: Patients investigated for possible bacterial meningitis at Wythenshawe Hospital, Manchester were identified retrospectively by a computer search of microbiology requests. The clinical presentation, laboratory investigations and early antibiotic management were reviewed. RESULTS: Only two of 26 patients who presented over a 9-month period were confirmed to have bacterial meningitis. Basic laboratory investigations were carried out on all patients. Samples for more specific investigations to determine the aetiological agent such as polymerase chain reaction, serology or throat swab culture, were frequently omitted by the clinicians. The choice of antibiotic therapy was generally appropriate for the treatment of bacterial meningitis with large variation in the dosage prescribed. Both patients with confirmed bacterial meningitis received appropriate doses. CONCLUSIONS: Compliance with BIS guidelines was incomplete in a group of patients presenting with possible bacterial meningitis. Access to a simplified outline of recommendations for early investigation and management of adult patients with possible bacterial meningitis may optimise guideline compliance and patient outcome. SUMMARY: Appropriate early investigation and management of bacterial meningitis in adults can optimise the outcome of this high mortality disease. Guidelines published by the BIS in 1999 detailed the recommended initial management of such patients [J Infect 39 (1999) 1]. In this study, the level of adherence to these guidelines was investigated for patients with possible bacterial meningitis who presented to a hospital in Manchester. The results showed that basic investigations such as peripheral blood count and blood cultures were almost invariably carried out, whereas, more specific investigations such as meningococcal PCR, serology and throat swab were frequently omitted. The choice of antibiotic was in agreement with the guidelines for the majority of cases but highlighted a considerable variability in dosage prescribed. The availability of a simple flow-chart outlining the early management of suspected bacterial meningitis and meningococcal septicaemia in adults produced by the BIS in 2003 may raise awareness of and compliance with their guidelines, thus optimising patient outcome.

Adolescent↗
PubMed1983

How useful is cerebrospinal fluid lactate estimation in differential diagnosis of meningitis?

Cerebrospinal fluid lactate (CSF) was measured by a rapid enzymatic method in 230 patients admitted with a suspected diagnosis of central nervous system infection. In all untreated cases of bacterial meningitis the levels exceeded 4.3 mmol/l and fell below 3.9 mmol/l in most patients with virus meningitis. We believe values of 3.9-4.3 mmol/l should be considered borderline as occasional CSF samples in cases of virus meningitis yield values in this range. However, distinction between untreated pyogenic meningitis and virus meningitis is rarely problematic in clinical practice, so routine use of the test as an emergency procedure offers no extra advantage. The test is unlikely to be of much help in differentiating partly treated bacterial meningitis from virus meningitis, but it is a valuable additional procedure for differentiating tuberculous meningitis from virus meningitis, highly modified bacterial meningitis and parameningeal septic states.

Brain Diseases↗
PubMedDate not supplied

[Meningitis in 154 children of a pediatric clinic in Germany: clinical and epidemiologic aspects].

In a retrospective study, the histories of the non-neonates treated for primary meningitis in the Pediatric Department of Mainz University Hospital between 1986 and 1989 were analyzed with regard to etiological, diagnostic, clinical and epidemiological criteria. In the period studied there were 37 cases of infectious meningitis (11 Neisseria meningitidis (29.7%), 7 H. influenzae (18.9%), 3 S. pneumoniae (8.1%), 16 other (43.2%)), and 117 cases of acute aseptic meningitis syndrome (12 mumps virus (10.3%), 3 Borrelia burgdorferi (7.7%), 3 FSME (2.6%), 2 herpes simplex virus, 91 other (77.8%)). Sixty-six percent of the patients were male. Of the infants with infectious meningitis, 68% were under 5 years old. In contrast, 69% of the children with noninfectious meningitis were aged 5 or older. While 70% of the infectious meningitis cases occurred in fall and winter, 64% of the cases of acute aseptic meningitis syndrome occurred in spring and summer. In differential diagnosis between infectious and acute aseptic meningitis syndrome maximal sensitivity was a CRP value exceeding 0.5 mg/dl, a CSF lactate value of over 3 mmol/l and a CSF cell count of over 2000/3 cells. In none of the cases did a second or third lumbar puncture furnish information additional to that which could have been deduced from physical examination and course of temperature. A second lumbar puncture failed to produce unexpected results, or have consequences for therapy, in any of the 14 cases with noninfectious meningitis. Of 37 infants with infectious disease, one (2.7%) died from the sequelae of pneumococcal meningitis. Recovery was partial in 8 (22.2%) of the 36 surviving infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Neoplastic vs inflammatory meningeal enhancement with Gd-DTPA.

We studied 40 consecutive patients clinically suspected of having meningeal disease, in whom both Gd-diethylenetriamine pentaacetic acid (DTPA)-enhanced magnetic resonance (MR) examinations and CSF or surgical pathologic samples were obtained. The MR examinations were retrospectively reviewed for the presence of abnormal meningeal enhancement, as well as pattern and site of enhancement. The MR findings correctly correlated with pathology results in 15 of 19 patients with suspected tumor involvement (including one true negative) and in 18 of 21 patients with suspected inflammatory meningeal conditions (including 2 true negatives). Pial enhancement was demonstrated in 62% (10 of 16) of patients with meningitis and in 29% (4 of 14) of patients with meningeal neoplastic involvement. A diffuse meningeal distribution was commonly present with inflammatory conditions (69%, 11 of 16). A nodular appearance was seen in two patients with tumor involvement of the meninges as well as in a single case of sarcoidosis but was not seen with infectious meningitis. Our data suggest that Gd-DTPA-enhanced MR imaging is sensitive to the presence of meningeal pathology but is nonspecific as to disease entity. Recognition of certain MR patterns in conjunction with clinical presentation may improve diagnosis and management of patients with suspected meningeal disease.

Contrast Media↗
PubMed1990

Determination of interleukin-2 (IL-2) and soluble IL-2 receptors (S-IL-2R) in serum and cerebrospinal fluid does not discriminate purulent and aseptic meningitis.

Elevated levels of soluble interleukin-2 receptors (S-IL-2R) but not interleukin-2 (IL-2) activity were found in sera from patients with aseptic meningitis, purulent meningitis, and meningism. Elevated levels of S-IL-2R in serum was also observed in 4/4 patients with bacterial pneumonia and 2/2 patients with infectious mononucleosis. The inflammation of the meninges was only reflected by an increase in S-IL-2R in cerebrospinal fluid (CSF) in 1/14 patients with aseptic meningitis and 3/10 patients with purulent meningitis. Further, IL-2 activity was only demonstrated in CSF from 2 patients with aseptic meningitis and 3 patients with purulent meningitis. In conclusion, neither S-IL-2R nor IL-2 in serum or CSF seem to have any value in the diagnosis of or discrimination between purulent meningitis and aseptic meningitis. Further, the elevation of S-IL-2R in serum is not specific for infections primarily fought by cytotoxic T-lymphocytes such as viral infections, but seems merely to reflect an unspecific activation of the immune system.

Biological Assay↗
PubMed1997

Meningitis in Hong Kong children, with special reference to the infrequency of haemophilus and meningococcal infection.

OBJECTIVE: To study the epidemiologic and aetiologic features of meningitis in children in Hong Kong. METHODOLOGY: A retrospective study of 85 children resident in the New Territory East region of Hong Kong admitted to a teaching Hospital because of meningitis during a 9 year period. RESULTS: Mycobacterium tuberculosis was the most common aetiological agent accounting for 13 cases (15.3%). Other bacteria accounted for 41 cases (48%); among these one fifth were caused by Haemophilus influenzae type b. The overall admission rates for tuberculous meningitis in Chinese children were 0.76/100,000 (95% CI 0.25-1.78) and 0.42/100,000 (CI 0.19-0.8) per year, respectively, for under 5 year olds and under 15 year olds. The overall annual incidence rates of bacterial meningitis other than tuberculous were 5.2/100,000 (CI 3.72-7.43) and 1.6/100,000 (CI 1.14-2.29) for Chinese children under 5 years and under 15 years, respectively. The annual incidence of H. influenzae meningitis in Chinese children under 5 years old was low at 1.1/100,000 (0.43-2.2). All five cases of meningococcal meningitis were in Vietnamese children (under 5 years of age incidence: 13.0/100,000 per year, CI 4.2-30.3). There were no cases of meningococcal meningitis in Chinese children during the 9 year period. CONCLUSION: M. tuberculosis was the most common aetiological agent of meningitis in Hong Kong children. The incidence of haemophilus or meningococcal meningitis was very low.

Adolescent↗
PubMed2005

Chronic meningitis in Thailand. Clinical characteristics, laboratory data and outcome in patients with specific reference to tuberculosis and cryptococcosis.

The charts of 114 consecutive patients with chronic meningitis admitted to a general hospital in Bangkok, Thailand, between 1993 and 1999 were retrospectively reviewed. The most common causative agents were Cryptococcus neoformans (54%) and Mycobacterium tuberculosis (37%). HIV and other underlying diseases had a major impact on the presentation of chronic cryptococcal meningitis patients. Compared to HIV-negative cryptococcal meningitis patients (21%), HIV-positives (79%) had a significantly lower incidence of focal signs (p = 0.02), hydrocephalus (p = 0.03) and seizures (p = 0.001) during hospital stay, furthermore, a lower leucocyte level, a significantly higher glucose level (p = 0.02) and a lower protein level (p = 0.03) in the first cerebrospinal fluid examination. Of the 43 patients with chronic tuberculous meningitis, only 3 were HIV positive. Focal neurologic deficits were found more frequently in tuberculous meningitis patients (p = 0.001) when compared to cryptococcal meningitis patients without HIV. Cerebral infarction on cerebral CT was indicative of tuberculous meningitis. Cryptococcal meningitis patients with HIV infection had a worse outcome compared to non-AIDS patients. Advanced stage of the disease on admission, decreased level of consciousness prior to and on the admission day and raised intracranial pressure above 40 cm H(2)O at any given time were predictive of a poor outcome in tuberculous meningitis patients.

Adolescent↗
PubMed2001

Predictors of bacterial meningitis in the era after Haemophilus influenzae.

OBJECTIVE: To determine if, in the era after Haemophilus influenzae type b, the cerebrospinal fluid (CSF) white blood cell (WBC) count can be safely used to stratify children suspected of having bacterial meningitis into low- and high-risk groups. DESIGN: Retrospective analysis of CSF samples. SETTING: Tertiary care pediatric center in Toronto, Ontario, between January 1, 1992, and October 1, 1996. PATIENTS: All CSF samples collected on children aged 2 months to 17 years were included. The final database consisted of 1617 atraumatic samples from children without prior neurologic or immunologic disease who underwent a lumbar puncture to assess the possibility of community-acquired bacterial meningitis. MAIN OUTCOME MEASURES: The predictive values of CSF WBC count, differential, protein, and glucose. RESULTS: There were 44 cases of bacterial meningitis. Five had 3 CSF WBCs per microliter or less, and 6 had 4 to 30 CSF WBCs per microliter. The negative predictive value of CSF specimens with 30 WBCs per microliter or less for bacterial meningitis was 99.3%. Cerebrospinal fluid samples with greater than 30 WBCs per microliter had a likelihood ratio for bacterial meningitis of 10.3 (95% confidence interval, 8.0-13.1) and a positive predictive value of 22.3%. Other significant predictors of bacterial meningitis included age, CSF glucose, protein, gram stain, CSF-serum glucose ratio, and peripheral blood band count. CONCLUSIONS: Given the occurrence of bacterial meningitis in children in the absence of CSF pleocytosis, other factors should be considered when managing children with suspected bacterial meningitis. Children older than 6 months with 30 CSF WBCs per microliter or less are at low risk for bacterial meningitis. If clinically stable and without other laboratory markers of bacterial meningitis, hospital admission and empiric antibiotic therapy may be unwarranted.

Adolescent↗
PubMed2006

Soluble triggering receptor expressed on myeloid cells 1: a biomarker for bacterial meningitis.

OBJECTIVE: To evaluate whether soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) in CSF can serve as a biomarker for the presence of bacterial meningitis and outcome in patients with this disease. DESIGN: Retrospective study of diagnostic accuracy. SETTING AND PATIENTS: CSF was collected from 92 adults with community-acquired bacterial meningitis who participated in the prospective Dutch Meningitis Cohort Study; 8 patients with viral meningitis and 9 healthy control subjects. RESULTS: CSF sTREM-1 levels were higher in patients with bacterial meningitis (median 82 pg/ml, range 0-988) than in those with viral meningitis (0 pg/ml, 0-48) and controls (0 pg/ml, 0-36). The diagnostic accuracy of sTREM-1 in discriminating between patients with and without bacterial meningitis, expressed as the area under the receiver operating characteristic curve, was 0.82. At a cutoff level of 20 pg/ml the sensitivity was 0.73 and specificity 0.77. In patients with bacterial meningitis CSF sTREM-1 levels were associated with mortality (survivors, median 73 pg/ml, range 0-449 pg/ml; nonsurvivors, 15 pg/ml, 0-988). CONCLUSIONS: Measuring sTREM-1 in CSF may be a valuable new additional approach to accurately diagnose bacterial meningitis and identify patients at high risk for adverse outcome. Therefore a prospective study of sTREM-1 as a biomarker in bacterial meningitis is needed.

Biomarkers↗
PubMed1998

Diagnostic value of atypical lymphocytes in cerebrospinal fluid from adults with enteroviral meningitis.

We have noted two morphologically distinct types of atypical lymphocytes (AL) in the cerebrospinal fluid (CSF) of adult patients with meningitis: one, which we designate type-I AL, with multilobulated nuclei resembling those of the abnormal cells in adult T-cell leukaemia (ATL); and another, type-II AL, characterized by large lymphocytes with basophilic cytoplasm and nuclei containing coarse chromatin. Type-I AL were detected in 25 of 39 patients (64%) with enteroviral and in 11 of 109 (11%) with aseptic meningitis presumed to be caused by other viruses, but not in meningitis resulting from Cryptococcus neofirmans (n = 14), Mycobacterium tuberculosis (n = 19) or acute bacterial infection (n = 49). Type-I AL were not seen in herpes zoster (n = 15) aseptic meningeal reactions (n = 15), or in leptomeningeal carcinomatosis (n = 14). Type-II AL were often present in meningitis of various aetiologies and in aseptic meningeal reactions, but not in leptomeningeal carcinomatosis. The presence of type-I AL in the CSF was found to be indicative of enteroviral meningitis with the highest predictive value (69%), while type-II AL had a lower diagnostic positive predictive value in meningitis of the five aetiologies above. Type-I AL immunostained for CD4, while type-II AL were stained for CD8. The presence of type-I AL in CSF strongly suggests enteroviral meningitis, which warrants careful follow-up without antifungal, antituberculous or antibacterial agents. However, type-I AL, which are likely to be virally transformed lymphocytes, must be distinguished from ATL cells, which frequently involve the meninges.

Adolescent↗
PubMed2004

Meningitis without a petechial rash in children in the Hib vaccine era.

AIMS: (1) To determine the causes of meningitis in children immunized with Hib vaccine, presenting without a non-blanching rash; (2) to review the use of dexamethasone in this group. METHOD: Retrospective review of all children with more then 10 white cells/mm(3) in their cerebrospinal fluid (CSF), admitted between January 1998 and August 2002. Children were excluded if they had a non-blanching rash on admission or if their discharge diagnosis was not meningitis. Local guidelines recommended dexamethasone to be given before antibiotics for children with meningitis and no rash. RESULTS: One hundred and eight children were identified. Causes of proven meningitis were: viral 41 (enterovirus 40), bacterial 22. CSF culture or PCR was the only diagnostic test in 31 children. Dexamethasone was given to 16 children. Length of admission was shorter in children with viral compared with bacterial meningitis (4 vs 8 days; P < 0.0001). SUMMARY: Viral meningitis is the commonest cause of meningitis without rash. Enteroviral PCR was the most useful test and needs to be widely available. Confirmation of enteroviral meningitis allowed early discharge. Few children were given dexamethasone, but only 5/108 may have benefited. CONCLUSIONS: The most common cause of meningitis without a rash in British children is enterovirus. The use of dexamethasone in children with meningitis without a rash should be reconsidered or, at least, individualised.

Adolescent↗
PubMed1999

High sensitivity and specificity of serum procalcitonin levels in adults with bacterial meningitis.

It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis. To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis. Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis. On the other hand, a serum procalcitonin level >0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis. Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults.

Adolescent↗