ABSTRACT
Introduction:
Acute bacterial meningitis is an important cause of morbidity and mortality in childhood. Early diagnosis and treatment are vital in emergency departments. The aim of this study was to determine the clinical and laboratory findings that can predict bacterial meningitis in the early period.
Methods:
Patients between one month and 17 years of age, who underwent lumbar puncture with pre-diagnosis of central nervous system infection in pediatric emergency department between January 2014 and December 2017, were evaluated. Demographic data, admission complaints, physical examination findings, laboratory results, and treatments were reviewed.
Results:
Four hundred-seventeen children (57.6% male) were included in the study. 119 cases (28.5%) were at the age of 3 months and under, 127 cases (30.5%) were at the age of 3 months-3 years and 171 cases (41%) were older than 3 years. Presence of neurological findings (169 cases, 40.5%), vomiting (118 cases, 28.3%), seizures (86 cases, 20.6%) and headache (76 cases, 18.2%) were frequently identified at presentation. Central nervous system infection was detected in 159 cases (38.1%) [32 cases (7.7%) bacterial meningitis and 127 cases (30.4%) aseptic meningitis]. In clinical complaints, vomiting was found to be significantly higher in both bacterial and aseptic meningitis than in non-meningitis patients. (p<0.001 and p=0.032, respectively), while headache and signs of meningeal irritation were higher in aseptic meningitis than in non-meningitis patients (p<0.001 and p<0.001, respectively). White blood cell count, neutrophil count and C-reactive protein values were found to differentiate bacterial meningitis (p=0.017, p <0.041 and p <0.004, respectively).
Conclusion:
In this study, vomiting as clinical findings and white blood cell count, neutrophil count and C-reactive protein values were found to be helpful in the differentiation of bacterial meningitis in patients who had lumbar puncture due to central nervous system infection.
Keywords:
Meningitis, child, lumbar puncture
References
1Posadas E, Fisher J. Pediatric bacterial meningitis: an update on early identification and management. Pediatr Emerg Med Pract. 2018;15:1-20. Epub 2018 Nov 1.
2Grandgirard D, Leib SL. Strategies to prevent neuronal damage in paediatric bacterial meningitis. Curr Opin Pediatr. 2006;18:112-8.
3Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39:1267-84.
4Van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitides. Clin Microbiol Infect. 2016;22(Suppl 3):37-62.
5Prober CG, Srinivas NS, Mathew R. Central nervous system ınfections. In: Robert M. Kliegman. Nelson Textbook of Pediatrics. 20th ed. Philadelphia,Pennsylvania: Elsevier,2016:2936-48.
6Nigrovic LE, Shah SS, Neuman MI. Correction of cerebrospinal fluid protein for the presence of red blood cells in children with a traumatic lumbar puncture. J Pediatr. 2011;159:158-9.
7Nigrovic LE, Kuppermann N, Malley R. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics. 2002;110:712-9.
8Ouchenir L, Renaud C, Khan S, Bitnun A, Boisvert AA, et al. The epidemiology, management, and outcomes of bacterial meningitis in ınfants. Pediatrics. 2017;140:e20170476.
9Snaebjarnardottir K, Erlendsdottir H, Reynisson IK, Kristinsson K, Halldórsdóttir S, et al. Bacterial meningitis in children in Iceland, 1975-2010: a nationwide epidemiological study. Scand J Infect Dis. 2013;45:819-24.
10Amarilyo G, Alper A, Ben-Tov A, Grisaru-Soen G. Diagnostic accuracy of clinical symptoms and signs in children with meningitis. Pediatr Emerg Care. 2011;27:196-9.
11Oostenbrink R, Moons KG, Donders AR, Grobbee DE, Moll HA. Prediction of bacterial meningitidis in children with meningeal signs: reduction of lumbar punctures. Acta Paediatr. 2001;90:611-7.
12Kaplan SL. Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. Infect Dis Clin North Am. 1999;13:579-94.
13Chinckar N, Mane M, Bhave S, Bapat S, Bavdekar A, et al. Diagnosis and outcome of acute bacterial meningitidis in early childhood. Indian Pediatr. 2002;39:914-21.
14Dubos F, Moulin F, Gajdos V, De Suremain N, Biscardi S, et al. Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitidis. J Pediatr. 2006;149:72-6.
15Ibrahim KA, Abdel-Wahab AA, Ibrahim AS. Diagnostic value of serum procalcitonin levels in children with meningitidis: a comparison with blood leukocyte count and C-reactive protein. J Pak Assoc. 2011;61:346-51.
16Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, et al. Serum procalcitonin level and other biologic markers to distinguish between bacterial and aseptic meningitidis in children: A European multicenter case cohort study. Arch Pediatr Adolesc Med. 2008;162:1157-63.
17Gerdes LU, Jørgensen PE, Nexø E, Wang P. C-reactive protein and bacterial meningitis: a meta-analysis. Scand J Clin Lab Invest. 1998;58:383-93.
18Sormunen P, Kallio MJ, Kilpi T, Peltola H. C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children. J Pediatr. 1999;134:725-9.
19Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, et al. Distinguish between bacterial and aseptic meningitidis in children: European comparison of two clinical decision rules. Arch Dis Child. 2010;95:963-7.
20Lee J, Kwon H, Lee JS, Kim HD, Kang HC. Applying the bacterial meningitidis score in children with cerebrospinal fluid pleocytosis: a single center’s experience. Korean J Pediatr. 2015;58:251-5.