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PubMed1998

Childhood bacterial meningitis in Japan.

Haemophilus influenzae type b (Hib) vaccines currently are not used in Japan, but interest in preventing H. influenzae disease by immunization has grown. We performed a retrospective survey for bacterial meningitis in 6 prefectures of Japan. Questionnaires requested the age, sex, clinical outcome and identity of the etiologic organism, if known, of all patients with meningitis younger than 16 years of age who were admitted during calendar year 1994. Of 876 hospitals within the 6 study prefectures, 363 (41.4%) returned a completed questionnaire. There were 1769 cases of meningitis reported, of which 160 (9%) were considered bacterial in origin. H. influenzae was the most common cause of bacterial meningitis, accounting for 68 cases (43%). Sixty-six cases (97%) of H. influenzae meningitis occurred in children 4 years of age or younger, and 27 (40%) occurred in children <1 year of age. Calculated incidence rates based on the population of children 4 years of age or less for each prefecture ranged from 3.4 to 9.9 cases per 100000 (mean, 4.7 cases/100000). H. influenzae is the most common cause of meningitis in Japan, and the estimated incidence rates from this study are very similar to those previously reported from Japan. More comprehensive, prospective surveillance studies will be needed to define better the incidence of Hib meningitis and to aid in making rational decisions regarding the use of Hib vaccination in Japan.

Adolescent↗
PubMed1991

Peripheral white blood cell counts and bacterial meningitis: implications regarding diagnostic efficacy in febrile children.

In order to investigate the clinical value of peripheral white blood cell variables for the diagnosis of bacterial meningitis among young, febrile children, we compared total peripheral white counts, total segmented neutrophil counts, total band counts, and the ratio of immature-to-total neutrophils (I:T ratio) among 46 children with bacterial meningitis, 130 children with aseptic meningitis, and 56 febrile children with culture confirmed extrameningeal bacterial infection. Children with bacterial meningitis were comparable to those with aseptic meningitis with respect to median total white blood cell counts and median total segmented neutrophil counts but had a significantly higher median total band count (1760/microliters vs 378/microliters, P = 0.0001) and a significantly higher median I:T ratio (0.40 vs 0.09, P less than 0.001). In contrast, children with bacterial meningitis were comparable to those with an extrameningeal bacterial infection with respect to median total band count but had a significantly lower median total peripheral white count (10,650/microliters vs 15,300/microliters, P = 0.0013), a lower median total segmented neutrophil count (4511/microliters vs 6796/microliters, P = 0.023), and a significantly higher median I:T ratio (0.40 vs 0.15, P less than 0.001). Children with meningitis who were bacteremic at presentation had a significantly lower total white cell count (P = 0.001) and significantly higher I:T ratio (P = 0.005) when compared with children who had an extrameningeal infection and concurrent bacteremia at presentation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

The diagnostic and predictive value of cerebrospinal fluid lactate in children with meningitis. Its relation to current diagnostic methods.

One hundred and thirty-three children with suspected meningitis aged from 11 days to 16 years were investigated with routine cerebrospinal fluid (CSF) laboratory methods: microscopy of a Gram-stained smear, bacterial culture, determination of leukocytes, lactate, and the CSF/blood glucose ratio. On the basis of bacterial cultures and clinical course, the children were classified into three groups: bacterial meningitis (n = 18), aseptic meningitis (n = 28), and a control group (n = 87). The main intention was to study the relation between current diagnostic methods and lactate. CSF lactate levels and cell counts, related significantly (p less than 0.01) better to the presence of bacterial meningitis than CSF/blood glucose ratios. Lactate levels exceed 2.4 mmol/l in all children with bacterial meningitis, but in none of the control group. Of 28 children with aseptic meningitis 3 had lactate in the range 2.5-2.7 mmol/l, while the others had values of 2.4 mmol/l or less. We consider CSF lactate to be the best predictor in the clinical decision to institute antibiotic treatment of children with suspected bacterial meningitis.

Adolescent↗
PubMedDate not supplied

Cerebrospinal fluid indices in cryptococcal and tuberculous meningitis: the spider web coagulum and its diagnostic significance.

The differentiation between a chronic cryptococcal meningitis and a chronic tuberculous meningitis may cause problems for the clinician only if standard microbiological methods are not applied to the diagnosis of both infections. In a male non-AIDS patient (50 y), 11 years after a suggested diagnosis of "tuberculous meningitis", meningoencephalitis with hydrocephalus was diagnosed and treated accordingly without success. Mycobacterium tuberculosis was never found. Because fibrin fibres of a spider web coagulum in the CSF resembled Aspergillus mycelium, the patient was then treated with amphotericin B + flucytosine. Finally, a mycological examination led to the true diagnosis: (1) In the CSF, resembling Aspergillus hyphae were found to be spider web coagulum fibres. (2) Cryptococcal meningoencephalitis based on the detection of Cryptococcus neoformans in CSF and its antigen in serum and CSF. - At post-mortem, cryptococcal meningoencephalitis was established as cause of death. Residual signs of tuberculosis could not be detected in the brain and the meninges. Common clinical similarities of cryptococcal and tuberculous meningitis and the possibility of a double infection are discussed. A comparison of the presence of Cr. neoformans in the meninges of non-AIDS and AIDS patients is made. The formation of spider web coagulum in the CSF is discussed. Proposals for the diagnosis, therapy and prophylaxis of cryptococcal meningitis are made.

Cryptococcosis↗
PubMed1981

Cerebrospinal fluid lactic acidosis in bacterial meningitis.

A rapid, microenzymatic method was used to measure cerebrospinal fluid lactate levels in 205 children with suspected bacterial meningitis. Fifty children with normal CSF containing fewer than 0.005 X 10(9)/l WBC, no segmented neutrophils, glucose 3.4 +/- 0.8 mmol/l (61.2 +/- 14.4 mg/100 ml), and a protein of less than 0.30 g/l had CSF lactate levels below 2.0 mmol/l (18 mg/100 ml) (mean and standard deviation 1.3 +/- 0.3 mmol/l (11.8 +/- 2.7 mg/100 ml)). In 31 cases of proved viral meningitis as with 58 cases of clinically diagnosed viral meningitis, levels were below 3.8 mmol/l (34.5 mg/100 ml), being 2.3 +/- 0.6 mmol/l (20.9 +/- 5.4 mg/100 ml), and 2.1 +/- 0.7 mmol/l (19.1 +/- 6.4 mg/100 ml) respectively. Sixty-six cases of bacterial meningitis had CSF lactate levels ranging from 3.9 mmol/l (35.4 mg/100 ml) to greater than 10.0 mmol/l (90.0 mg/100 ml). Longitudinal studies in 7 children with bacterial meningitis showed that cerebrospinal fluid lactate levels differentiated bacterial from viral meningitis up to 4 days after starting treatment with antibiotics. Use of CSF lactate measurement for monitoring the efficacy of treatment is illustrated in a case of bacterial meningitis due to Pseudomonas aeruginosa. The origin of the cerebrospinal fluid lactate acidosis and the role of lactate in the pathophysiological cycle leading to intensification of brain tissue hypoxia and cellular damage is discussed with respect to the short-term prognosis and the long-term neurological sequelae.

Acidosis↗
PubMed1994

Bacterial meningitis in Swaziland: an 18 month prospective study of its impact.

STUDY OBJECTIVE: To describe the epidemiology, clinical features, and outcome of bacterial meningitis in Swaziland. DESIGN: Prospective study of patients diagnosed as having meningitis of nonviral aetiology during an 18 month period from February 1991 to July 1992. SETTING: Four regional hospitals covering the population of the four districts in Swaziland. SUBJECTS: All patients with non-viral meningitis admitted to hospital within the study period. MAIN RESULTS: Altogether 85 patients were reported to have bacterial meningitis: 48.3% were aged under 1 year. Causative organisms were identified in 60% of cases, and Streptococcus pneumoniae was found to be the commonest (49% of cases). Overall, case fatality was 38.8% for all age groups, and 62.5% (15 of 25) for adults. Neurological sequelae occurred in 22.4%. Three of the adult cases were HIV seropositive. Seizures, but not duration of symptoms before admission, were associated with a poor prognosis. There was a significant rise in incidence related to a period of drought. Fifteen patients were reported with tuberculous meningitis, of whom five were known to be HIV seropositive; the case fatality was 73.3%. CONCLUSIONS: The aetiology and age distribution of cases of meningitis differs greatly from that in developed countries. Rising HIV infection may have an important impact on the future incidence of meningitis. The high case mortality found should encourage efforts towards earlier diagnosis and treatment, and strengthens the need to develop appropriate vaccines.

Adolescent↗
PubMed1980

Cerebrospinal fluid outflow resistance in rabbits with experimental meningitis. Alterations with penicillin and methylprednisolone.

Acute bacterial meningitis may be associated with increased intracranial pressure, neurological sequelae such as communicating hydrocephalus, and a slow response to antibiotic therapy. Alterations in cerebrospinal hydrodynamics are at least partially responsible for these complications. Constant, low-flow short-duration manometric infusion studies through a hollow-bore pressure monitoring device in direct continuity with the supracortical subarachnoid space were performed in rabbits with experimental meningitis. Maximal resistance to cerebrospinal fluid (CSF) outflow from the subarachnoid to vascular space was markedly increaed in acute pneumococcal meningitis when compared to control, uninfected animals (6.77 +/- 3.52 vs. 0.26 +/- 0.04 mm Hg/microliter per min, P less than 0.001). Similar elevations (8.93 +/- 4.15 mm Hg/microliter per min were found in experimental Escherichia coli meningitis. Despite eradication of viable bacteria from the CSF by penicillin therapy during the acute stage of pneumococcal meningitis, resistance remained elevated (6.07 +/- 4.68 mm Hg/microliter per min) and had not returned to normal up to 15 d later. Administration of methylprednisolone during the early stages of acute pneumococcal meningitis reduced mean peak outflow resistance towards control values (0.59 mm Hg/microliter per min) and no "rebound" effect was apparent 24 h later. These hydrodynamic alterations in experimental meningitis prevent normal CSF absorption and decrease the ability of the bran to compensate for changes in intracranial volume and pressure.

Animals↗
PubMed1994

The use of cytokine and C-reactive protein measurements in cerebrospinal fluid during acute infective meningitis.

Cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP), tumour necrosis factor alpha (TNF), interleukin-6 (IL-6), total protein (TP) and white cell count with differential (WCC) have been measured in 24 patients presenting with acute bacterial or viral meningitis and also in a non-infected, non-inflamed control group (n = 24). In acute viral meningitis, CRP levels were not raised when compared to controls and there was a discordance between high levels of the primary inflammatory mediators (IL-6 and TNF) and the low measured CRP levels. CRP levels were raised in cases of bacterial meningitis. A concentration of 100 ng/mL CRP had a sensitivity of 87% for bacterial meningitis. TNF concentrations in the CSF were significantly raised in cases of acute bacterial meningitis (P < 0.001). Smaller but variable elevations were seen in the patients with acute viral meningitis. One patient, who succumbed to bacterial infection, showed low CSF levels of CRP, TNF and WCC but an elevated IL-6 concentration. Another, presenting with low CSF WCC, had raised concentrations of CRP, TNF and IL-6 which pointed to the correct diagnosis of acute bacterial meningitis. The development of methods yielding rapid analysis for these cytokines together with a sensitive assay for CRP in CSF would be a useful adjunct to conventional investigation.

C-Reactive Protein↗
PubMed2006

Acute bacterial meningitis in children presenting to the Royal Liverpool Children's Hospital, Liverpool, UK and the Queen Elizabeth Central Hospital in Blantyre, Malawi: a world of difference.

BACKGROUND: Bacterial meningitis is a serious childhood illness worldwide. Children can now be immunised against meningitis with conjugate vaccines. The outcome of bacterial meningitis in British and Malawian children before the introduction of these vaccines was compared. METHODS: All children with culture-positive bacterial meningitis treated in the Royal Liverpool Children's Hospital (RLCH), UK during 1984-1991 (n=197) and in the Children's Unit, Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi during 1996-1997 (n=175) were studied. RESULTS: Children at QECH presented later and were more often comatose and malnourished. Mortality was 7% in RLCH compared with 41% in QECH. Three organisms caused most cases of meningitis: N. meningitidis 56% vs 4%, H. influenzae b 27% vs 25%, and S. pneumoniae 11% vs 35% in RLCH and QECH, respectively. Mortality was lower in RLCH for each organism: N. meningitidis 10% vs 28%, H. influenzae b 6% vs 43%, S. pneumoniae 0% vs 46%. CONCLUSIONS: Mortality from bacterial meningitis in Malawian children is much higher than in British children, even when infected with the same organisms. This might be owing to delay in presentation, malnutrition and HIV infection. Immunisation of Malawian children with conjugate vaccines should continue to develop since their risk of dying from meningitis is five times greater than that of British children.

Acute Disease↗
PubMed2006

Arthritis in adults with community-acquired bacterial meningitis: a prospective cohort study.

BACKGROUND: Although the coexistence of bacterial meningitis and arthritis has been noted in several studies, it remains unclear how often both conditions occur simultaneously. METHODS: We evaluated the presence of arthritis in a prospective nationwide cohort of 696 episodes of community-acquired bacterial meningitis, confirmed by culture of cerebrospinal fluid, which occurred in patients aged >16 years. The diagnosis of arthritis was based upon the judgment of the treating physician. To identify differences between groups Fisher exact statistics and the Mann-Whitney U test were used. RESULTS: Arthritis was recorded in 48 of 696 (7%) episodes of community-acquired bacterial meningitis in adults. Joint-fluid aspirations were performed in 23 of 48 patients (48%) and joint-fluid cultures yielded bacteria in 6 of 23 patients (26%). Arthritis occurred most frequently in patients with meningococcal meningitis (12%). Of the 48 patients with bacterial meningitis and coexisting arthritis, four died (8%) and 10 (23%) had residual joint symptoms. CONCLUSION: Arthritis is a common manifestation in patients with community-acquired bacterial meningitis. Functional outcome of arthritis in bacterial meningitis is generally good because meningococcal arthritis is usually immune-mediated, and pneumococcal arthritis is generally less deforming than staphylococcal arthritis. Nevertheless, additional therapeutic measures should be considered if clinical course is complicated by arthritis. In patients with infectious arthritis prolonged antibiotic therapy is mandatory.

Adolescent↗
PubMed2006

Prediction of Lyme meningitis in children from a Lyme disease-endemic region: a logistic-regression model using history, physical, and laboratory findings.

BACKGROUND: Differentiating Lyme meningitis (LM) from other forms of aseptic meningitis (AM) in children is a common diagnostic dilemma in Lyme disease-endemic regions. Prior studies have compared clinical characteristics of patients with LM versus patients with documented enteroviral infections. No large studies have compared patients with LM to all patients presenting with AM and attempted to define a clinical prediction model. OBJECTIVE: To create a statistical model to predict LM versus AM in children based on history, physical, and laboratory findings during the initial presentation of meningitis. METHODS: Children older than 2 years presenting to the Alfred I. duPont Hospital for Children between October 1999 and September 2004 were identified if both Lyme serology and cerebrospinal fluid (CSF) were collected during the same hospital encounter. Patients were considered to have Lyme disease only if they met Centers for Disease Control and Prevention criteria (documented erythema migrans and/or positive Lyme serology). Patients were eligible for study inclusion if they had documented meningitis (CSF white blood cell count: >8 per mm3). Retrospective chart review abstracted duration of headache and cranial neuritis (papilledema or cranial nerve palsy) on physical examination and percent CSF mononuclear cells. Using logistic-regression analysis, the type of meningitis (LM versus AM) was simultaneously regressed on these 3 variables. The Hosmer-Lemeshow test was performed and the area under the receiver operating characteristic curve was calculated. RESULTS: A total of 175 children with meningitis were included in the final statistical model. Logistic-regression analysis included 27 patients with LM and 148 patients classified as having AM. Duration of headache, cranial neuritis, and percent CSF mononuclear cells independently predicted LM. The Hosmer-Lemeshow test revealed a good fit for the model, and the Nagelkerke R2 effect size demonstrated good predictive efficacy. Odds ratios based on the logistic-regression results were calculated for these variables. The final model was transformed into a clinical prediction model that allows practitioners to calculate the probability of a child having LM. CONCLUSIONS: Longer duration of headache, presence of cranial neuritis, and predominance of CSF mononuclear cells are predictive of LM in children presenting with meningitis in a Lyme disease-endemic region. The clinical prediction model can help guide the clinician about the need for parenteral antibiotics while awaiting serology results.

Child↗
PubMed1982

Cerebrospinal fluid lactate in the diagnosis of meningitis. Diagnostic value compared to standard biochemical methods.

Cerebrospinal fluid (CSF) lactate was determined in 245 patients by means of a rapid enzymatic method (Monotest Lactate). The mean value was 1.61 mmol/l (range 0.79-3.33) in 104 control patients, 2.06 mmol/l (range 0.76-4.31) in 121 patients with aseptic meningitis, and 8.18 mmol/l (range 1.77-19.21) in 20 patients with bacterial meningitis. In most of the patients CSF protein and the CSF/blood glucose quotient were also determined. Lactate and glucose quotient differentiated equally well between aseptic and bacterial meningitis while protein was somewhat less useful. Suitable values for discrimination between aseptic and bacterial meningitis were judged to be 3.0 mmol/l for CSF lactate, 1.0 g/l for CSF protein and 0.5 for the glucose quotient. Combinations of tests improved the diagnostic accuracy in aseptic but not in bacterial meningitis. In 2 patients with bacterial meningitis all tests failed. CSF lactate may be used as a supplementary aid in the diagnosis of meningitis. Its diagnostic efficacy was equal to but not better than that of the traditional methods.

Adolescent↗
PubMed2001

Intracisternally localized bacterial DNA containing CpG motifs induces meningitis.

Unmethylated CpG motifs are frequently found in bacterial DNA, and have recently been shown to exert immunostimulatory effects on leukocytes. Since bacterial infections in the CNS will lead to local release of prokaryotic DNA, we wanted to investigate whether such an event might trigger meningitis. To that end, we have intracisternally injected mice and rats with bacterial DNA and oligonucleotides containing CpG motifs. Histopathological signs of meningitis were evident within 12 h and lasted for at least 14 days, and were characterized by an influx of monocytic, Mac-3(+) cells and by a lack of T lymphocytes. To study the mechanisms whereby unmethylated CpG DNA gives rise to meningitis, we deleted the monocyte/macrophage population leading to abrogation of brain inflammation. Also, interaction with NF-kappaB using antisense technology led to down-regulation of proinflammatory cytokine production and frequency of meningitis. Furthermore, specific interactions with vascular selectin expression and inhibition of NO synthase led to a significant amelioration of meningitis, altogether indicating that this condition is dependent on macrophages and their products. In contrast, neutrophils, NK cells, T/B lymphocytes, IL-12, and complement system were not instrumental in meningitis triggered by bacterial DNA containing CpG motifs. This study proves that bacterial DNA containing unmethylated CpG motifs induces meningitis, and indicates that this condition is mediated in vivo by activated macrophages.

Adjuvants, Immunologic↗
PubMed1980

Meningitis caused by gram-negative bacilli.

Thirty adults with meningitis caused by gram-negative bacilli were observed from 1968 to 1978 at four hospitals associated with Boston University School of Medicine. Equal numbers of two distinct types of gram-negative bacillary meningitis--spontaneously occurring meningitis and meningitis after neurosurgery--were found. Spontaneously occurring meningitis appeared to be caused most often by Escherichia coli and Haemophilus influenzae. Meningitis occurring after neurosurgical procedures was more insidious in onset, more protracted in course, and more often caused by organisms resistant to multilple antibiotics. Approaches to therapy are based on the differences in character of these two types of meningitis.

Adult↗
PubMed1999

[Evaluation of the polymerase chain reaction technique for the diagnosis of meningitis caused by Neisseria meningitidis and Haemophilus influenzae].

BACKGROUND: Bacterial meningitis is a severe infection of the central nervous system (CNS), most frequently caused by Neisseria meningitidis in our setting. Microbiologic diagnosis of bacterial meningitis is not enough sensitive because its efficiency can be affected by the therapeutic regimen given to the patient. Polymerase chain reaction (PCR) can provide a more sensitive diagnosis and allow us to get an earlier result. OBJECTIVES: To assess the sensitivity and specificity of a PCR technique for the diagnosis of meningitis caused by N. meningitidis and Haemophilus influenzae. MATERIAL AND METHODS: Ninety-six patients who were attended because of suspected bacterial meningitis on the Hospital de Sant Joan de Déu, Corporació Sanitària Parc Taulí and Hospital de la Santa Creu i Sant Pau, and had negative results by conventional laboratory methods, were selected for the study. A total of 99 cerebrospinal fluid samples (CSF) were obtained and evaluated for PCR. DNA extracts of the CSF samples were amplified by universal primers. Amplification products were hybridized with specific probes for Haemophilus genus and N. meningitidis. Positive and negative controls were included to asses the reliability of PCR. RESULTS: Eight of the 99 CSF samples (8%) were positive by PCR and subsequent hybridization with the specific probe of N. meningitidis. None of the amplicons hybridized with the probe of Haemophilus genus. Thirteen percent of the patients (8/59) with clinical suspicious of non-neonatal sepsis or meningitis were diagnosed by PCR, amongst them, 36% of the cases (4/11) with initial diagnosis of meningococcal sepsis or meningitis. CONCLUSIONS: The sensitivity and the specificity of the PCR technique afford a complementary method to conventional ones, in special for the diagnosis of meningococcal meningitis in the group of pediatric patients.

Child↗
PubMed2002

Profile of childhood meningitis in a hospital in South West Saudi Arabia.

OBJECTIVE: To study the pattern of meningitis in children admitted to King Faisal Military Hospital, Aseer region, Kingdom of Saudi Arabia, during the period 1987 to 2000. Particular emphasis was on Hemophilus influenzae meningitis. METHODS: All the patients between the age of one month and 13 years of age, who were diagnosed with meningitis during that period, using the International Classification of Disease 9 coding system, were included in this study. RESULTS: A total of 43 cases of meningitis based on the cerebrospinal fluid results were found. The majority (74%) of these cases were less than 2 years of age. Twenty-four patients had a positive cerebrospinal fluid culture. Fifteen of them (62.5%) were due to Hemophilus influenzae. The others were due to Streptococcus pneumoniae, Klebsiella pneumoniae, Staphylococcus aureus and group B Streptococcus. The remaining 19 patients had cerebrospinal fluid findings consistent with bacterial meningitis CONCLUSION: Meningitis due to Hemophilus influenzae, constitutes a large percentage of childhood meningitis in the Kingdom of Saudi Arabia. This increase is highly attributed to the lack of vaccination against this organism. We recommend introducing this vaccine as a part of the routine vaccination schedule for all children.

Child, Preschool↗
PubMed2005

[Clear-fluid meningitis in HIV-infected patients in Dakar].

This retrospective study was carried out to describe the epidemiological, clinical and aetiological aspects of clear-fluid meningitis among HIV-positive patients admitted at the Infectious Diseases Clinic in Fann Teaching Hospital in Dakar Data were collected for analysis from patients files recorded from January 1, 2001 to December 31, 2003. Forty-six cases of clear-fluid meningitis were found among HIV-infected patients, representing 51.7% of cerebro-meningeal diseases and 92% of meningitis encountered in those patients. Sex ratio MIF was 1.5 and the mean age of patients was 40.7 years [range 23-61 years]. Clinical presentations comprised headache (80%), fever (67%), meningeal syndrome (74%), coma (28%), convulsions (9%), focal neurological deficits (11%), cranial nerves dysfunction (9%). Aetiologies were represented by neuromeningeal cryptococcosis (29 cases) and tuberculous meningitis (5 cases). In 26% of cases no aetiology was found. The case fatality rate was 63% overall (29 deaths) and 83.3% among cases with unknown aetiology. It did not vary significantly according to epidemiological and clinical variables studied. Neurological sequelae were found in 4 patients who recovered. A better management of clear-fluid meningitis among HIV-positive patients should benefit from the reinforcement of our diagnostic capacities, the availability of effective systemic antifungal drugs and the prevention of opportunistic infections in the course of HIV/AIDS infection.

Adult↗
PubMed2005

C reactive protein for differentiating bacterial from aseptic meningitis in Thai patients.

OBJECTIVES: To evaluate the efficacy of serum CRP level differentiating between bacterial and aseptic meningitis in Thai patients. MATERIAL AND METHOD: The authors measured the serum CRP level in patients who were diagnosed clinically as bacterial and aseptic meningitis. RESULTS: The authors evaluated 32 subjects, 12 with bacterial meningitis (all males) and 20 with aseptic meningitis (13 males, 7 females). The mean serum CRP level in the bacterial meningitis and aseptic meningitis group was 209.25 +/- 105.34 (range, 65 to 420) and 67.05 +/- 40.81 (range, 10 to 169) mg/L, respectively (p < 0.001). CONCLUSIONS: Serum CRP can help differentiate between bacterial and aseptic meningitis.

Adolescent↗