scholarly journals A Diagnostic Scoring System for Distinguishing between Tuberculous and Bacterial Meningitis Based on Clinical and Laboratory Findings

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yongyan He ◽  
Yueli Zou ◽  
Junying He ◽  
Hui Bu ◽  
Yaling Liu
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cell Count ◽  
Tuberculous Meningitis ◽  
Scoring System ◽  
White Cell Count ◽  
Characteristic Curve ◽  
Chinese Patients ◽  
Laboratory Findings ◽  
Microbial Resources

It is very difficult to diagnose and distinguish tuberculous meningitis, and the current laboratory methods are unsubstantial in developing countries. The study is aimed at creating a scoring system on the basis of basic laboratory and clinical achievements that could be used as diagnostic aid for tuberculous meningitis for Chinese patients. A retrospective study of cases was conducted for comparison between clinical characteristics and laboratory features of 241 patients on admission who conformed to inclusion criteria of tuberculous meningitis ( n = 141 ) or bacterial meningitis ( n = 100 ). Logistic regression was employed to establish a diagnostic formula to distinguish between tuberculous meningitis and bacterial meningitis. The receiver operating characteristic curve analysis was applied to determine the best diagnostic critical point of the diagnostic formula. It was found that five variables (disease course, white blood cell count, serum sodium, total white cell count of cerebrospinal fluid, and neutrophil proportion in cerebrospinal fluid) were independently associated with tuberculous meningitis. The 87% sensitivity and 94% specificity were included in the diagnostic scoring system derived from these variables. Especially in the case of limited microbial resources, doctors can use this diagnostic scoring system to distinguish tuberculous meningitis from bacterial meningitis.

scholarly journals Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Leonardo Silva de Araujo ◽  
Kevin Pessler ◽  
Kurt-Wolfram Sühs ◽  
Natalia Novoselova ◽  
Frank Klawonn ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Cell Count ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Viral Meningitis ◽  
Acute Bacterial Meningitis ◽  
Membrane Phospholipids ◽  
Cns Disorders

Abstract Background The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell’s palsy, Tourette syndrome, normal pressure hydrocephalus). Results PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman’s ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. Conclusions Increased CSF PC ae C44:6 concentrations in bacterial meningitis likely reflect ongoing CNS cell membrane stress or damage and have potential as additional, sensitive biomarker to diagnose bacterial meningitis in patients with less pronounced neuroinflammation.

Diagnostic Value of Clinical and Laboratory Findings in Childhood Meningitis

2019 ◽  
Vol 15 (02) ◽  
pp. 079-085
Author(s):  
Melike Emiroglu ◽  
Recep Kesli ◽  
Murat Kilicaslan
Keyword(s):  
Cerebrospinal Fluid ◽  
Statistical Analysis ◽  
Bacterial Meningitis ◽  
Diagnostic Value ◽  
Human Enterovirus ◽  
Study Patient ◽  
Laboratory Findings ◽  
Cell Counts ◽  
Acute Meningitis ◽  
Meningitis In Children

Abstract Objective Acute meningitis in childhood is a serious infectious disease that requires immediate medical assessment to ensure appropriate treatment and healthy outcomes. The aim of this retrospective study was to evaluate clinical and laboratory findings in the diagnosis of acute meningitis in children. Materials and Methods Between February 2011 and March 2013, 258 children aged between 1 month and 18 years who were admitted to Konya Training and Research Hospital, Turkey, with clinically suspected meningitis and undergoing lumbar puncture were enrolled in the study. Patient charts were reviewed using a standardized data collection tool. Fifty-nine patients were excluded because of incomplete data or because they did not meet the enrollment criteria. Further statistical analysis was conducted on the remaining 199 patients. The diagnostic values of clinical and laboratory findings for acute meningitis were investigated. IBM SPSS 21.0 for Windows was used for the statistical analysis. Results Of the 199 patients (61.3% male; median age: 24 months), 101 (50.8%) were diagnosed with meningitis. A definitive diagnosis of bacterial meningitis was made in 16 patients, while 5 patients had probable bacterial meningitis. In addition, 80 patients diagnosed as aseptic meningitis and 47 of these patients had human enterovirus meningitis. Headache was more common in patients with meningitis. In patients without meningitis, the most common complaints were seizures or seizures accompanied by fever. Erythrocyte sedimentation rates (ESR), levels of cerebrospinal fluid protein, and cell counts in cerebrospinal fluid examinations were higher in the meningitis group. C-reactive protein, ESR, and procalcitonin higher than 22.55 mg/L, 36.5 mm/hour, and 6.795 mg/mL, respectively, indicated bacterial meningitis. Conclusion Our results showed that a combination of clinical and laboratory markers could facilitate recognition of bacterial meningitis in children.

Early (chemical) diagnosis of bacterial meningitis--cerebrospinal fluid glucose, lactate, and lactate dehydrogenase compared.

1981 ◽  
Vol 27 (8) ◽  
pp. 1431-1434 ◽  
Author(s):  
J A Knight ◽  
S M Dudek ◽  
R E Haymond
Keyword(s):  
Cerebrospinal Fluid ◽  
Lactate Dehydrogenase ◽  
Bacterial Meningitis ◽  
Cell Count ◽  
Reference Intervals ◽  
Fluid Cell ◽  
Early Indicators

Abstract Both lactate and lactate dehydrogenase are more sensitive as early indicators of bacterial meningitis than is glucose, and both appear to help differentiate aseptic from bacterial meningitis. In selected cases, lactate dehydrogenase may be more sensitive than lactate. We also give reference intervals for cerebrospinal fluid cell count, glucose, lactate, and lactate dehydrogenase.

Cerebrospinal fluid white cell count: discriminatory or otherwise for enteroviral meningitis in infants and young children?

2015 ◽  
Vol 22 (2) ◽  
pp. 213-217 ◽  
Author(s):  
Natalie Woon Hui Tan ◽  
Elis Yuexian Lee ◽  
Gloria Mei Chin Khoo ◽  
Nancy Wen Sim Tee ◽  
Subramania Krishnamoorthy ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Young Children ◽  
Cell Count ◽  
White Cell Count ◽  
White Cell ◽  
Enteroviral Meningitis ◽  
Infants And Young Children

scholarly journals Chronic meningitis caused by Erysipelothrix rhusiopathiae

2007 ◽  
Vol 56 (10) ◽  
pp. 1405-1406 ◽  
Author(s):  
Suk Ran Kim ◽  
Min Jung Kwon ◽  
Jang Ho Lee ◽  
Nam Yong Lee
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Antimicrobial Treatment ◽  
Erysipelothrix Rhusiopathiae ◽  
Chronic Meningitis ◽  
Laboratory Findings ◽  
Neurological Sequelae ◽  
Intracranial Infection

A 47-year-old man presented with headache, nausea, vomiting and fever. Laboratory findings including analysis of cerebrospinal fluid suggested bacterial meningitis. Erysipelothrix rhusiopathiae was identified in cultures of cerebrospinal fluid. The patient recovered without any neurological sequelae after antimicrobial treatment. It is interesting that intracranial infection by E. rhusiopathiae reappeared after scores of years and that it presented with absence of an underlying cause or bacteraemia.

scholarly journals Diagnostic Cerebrospinal Fluid Biomarker Discovery and Validation in Patients with Central Nervous System Infections

2020 ◽  
Author(s):  
Tran Tan Thanh ◽  
Climent Casals-Pascual ◽  
Nguyen Thi Han Ny ◽  
Nghiem My Ngoc ◽  
Ronald Geskus ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Diagnostic Performance ◽  
Biomarker Discovery ◽  
Characteristic Curve ◽  
Accurate Identification ◽  
Cns Infections ◽  
Potential Biomarker

ABSTRACTBackgroundCentral nervous system (CNS) infections are common causes of morbidity and mortality worldwide. Rapid, accurate identification of the likely cause is essential for clinical management and the early initiation of antimicrobial therapy, which potentially improves clinical outcome.MethodsWe applied liquid chromatography tandem mass-spectrometry on 45 cerebrospinal fluid (CSF) samples from a cohort of adults with/without CNS infections to discover potential diagnostic protein biomarkers. We then validated the diagnostic performance of a selected biomarker candidate in an independent cohort of 364 consecutively treated adults with CNS infections admitted to a referral hospital in southern Vietnam.ResultsIn the discovery cohort, we identified lipocalin 2 (LCN2) as a potential biomarker of bacterial meningitis. The analysis of the validation cohort showed that LCN2 could discriminate bacterial meningitis from other CNS infections, including tuberculous meningitis, cryptococcal meningitis and viral/antibody-mediated encephalitis (sensitivity: 0.88 (95% confident interval (CI): 0.77–0.94), specificity: 0.91 (95%CI: 0.88–0.94) and diagnostic odd ratio: 73.8 (95%CI: 31.8–171.4)). LCN2 outperformed other CSF markers (leukocytes, glucose, protein and lactate) commonly used in routine care worldwide. The combination of LCN2 and these four routine CSF markers resulted in the highest diagnostic performance for bacterial meningitis (area under receiver-operating-characteristic-curve 0.96; 95%CI: 0.93–0.99).ConclusionsOur results suggest that LCN2 is a sensitive and specific biomarker for discriminating bacterial meningitis from a broad spectrum of CNS infections. A prospective study is needed to further assess the diagnostic utility of LCN2 in the diagnosis and management of CNS infections.

Development and Validation of a New Scoring System for the Early Diagnosis of Tuberculous Meningitis in Adults

2020 ◽  
Author(s):  
Yuying LU ◽  
Chen ZHANG ◽  
Zhongyang HU ◽  
Guang YAO ◽  
Qinghua ZHANG ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Tuberculous Meningitis ◽  
Scoring System ◽  
Clinical Laboratory ◽  
Early Stage ◽  
Characteristic Curve ◽  
Clinical Manifestations ◽  
Symptom Duration ◽  
Diagnostic Score

Abstract Background The absence of a sufficiently accurate and efficient diagnosis of tuberculous meningitis (TBM) is major obstacle to delayed treatment, and its non-specific clinical manifestations easily mimic the central nervous system infections caused by other causes, including virus, bacteria, and cryptococcus. This study aims to develop and validate a diagnostic score system for TBM in HIV-uninfected adults by simultaneously comparing TBM with viral meningitis (VM), bacterial meningitis (BM), and cryptococcal meningitis (CM). Methods Twenty-nine factors (including clinical, laboratory and imaging) were assessed among 382 patients who satisfied inclusion criteria for TBM (n = 113), VM (n = 143), BM (n = 65) and CM (n = 61). Independent predictors for the diagnosis of TBM were obtained by logistic regression to establish a diagnostic scoring system. The performance of this scoring system was evaluated using a prospective validation cohort. Results Nine factors independently associated with the diagnosis of TBM: symptom duration (10–30 days), systemic symptoms, evidence of extra-central nervous system tuberculosis, cerebrospinal fluid (CSF) leukocyte count (100-500∗106 /mL), CSF neutrophil proportion (20%-75%), CSF protein (> 1 g/L), low serum sodium (< 137 mmol/L), meningeal enhancement, and brain parenchymal nodules (tuberculomas). The CSF neutrophil proportion was assigned a score of 2 and all other factors were assigned a score of 1. A score of at least five was suggestive of TBM with a sensitivity of 85.8% and a specificity of 87.7%, and the area under the receiver operating characteristic curve (AUC) was 0.927. When applied prospectively to an additional 72 patients (21 with TBM, 27 with VM, 14 with BM, and 10 with CM), the sensitivity, specificity, accuracy, and AUC values of this scoring model were 90.5%, 86.3%, 87.5%, and 0.944, respectively. Conclusions For differential diagnosis between TBM and other causes of meningitis (VM,CM and BM), we developed and validated a new weighted scoring system. The application of this scoring system can help diagnose TBM more efficiently in the early stage.

Pragmatic and evidence-based approach to paediatric cerebrospinal fluid reference limits for white cell count and concentrations of total protein and glucose

2018 ◽  
Vol 71 (10) ◽  
pp. 932-935 ◽  
Author(s):  
Nicky Josman ◽  
Nancy W S Tee ◽  
Matthias Maiwald ◽  
Liat Hui Loo ◽  
Clement K M Ho
Keyword(s):  
Cerebrospinal Fluid ◽  
Cell Count ◽  
Total Protein ◽  
Clinical Laboratory ◽  
White Cell Count ◽  
Reference Intervals ◽  
White Cell ◽  
Invasive Procedures ◽  
Paediatric Hospital ◽  
Reference Limits

BackgroundIt is often impractical for each laboratory to establish its own paediatric reference intervals. This is particularly true for specimen types collected using invasive procedures, for example, cerebrospinal fluid (CSF).MethodsPublished CSF reference intervals for white cell count, and concentrations of total protein and glucose were reviewed by stakeholders in a paediatric hospital. Consensus reference intervals for the three CSF parameters were then subjected to verification using guidelines from the Clinical Laboratory Standards Institute and residual CSF specimens.ResultsConsensus paediatric reference intervals adapted from published studies with minor modifications were locally verified as follows. White cell count (x106 cells/L): 0–20 (<1 month); 0–10 (1–2 months); 0–5 (>2 months). Total protein (g/L): 0.3–1.2 (<1 month); 0.2–0.6 (1–3 months); 0.1–0.4 (>3 months). Glucose (mmol/L): 2.0–5.6 (<6 months); 2.4–4.3 (6 months or older).

Sign in / Sign up

Export Citation Format

Share Document