Characterization of Lyme Meningitis and Comparison With Viral Meningitis in Children

Objective. It is frequently taught that lumbar puncture is a mandatory procedure in many or all children who have fever and a seizure, because the convulsion may represent the sole manifestation of bacterial meningitis. We attempted to determine the incidence of this occult manifestation of meningitis. Design. Retrospective case series. Setting and patients. 503 consecutive cases of meningitis in children aged 2 months to 15 years seen at two referral hospitals during a 20-year period. Main outcome measures. Signs and symptoms of meningitis in patients having associated seizures. Results. Meningitis was associated with seizures in 115 cases (23%), and 105 of these children were either obtunded or comatose at their first visit with a physician after the seizure. The remaining 10 had relatively normal levels of consciousness and either were believed to have viral meningitis (2) or possessed straightforward indications for lumbar puncture: nuchal rigidity (6), prolonged focal seizure (1), or multiple seizures and a petechial rash (1). No cases of occult bacterial meningitis were found. Conclusion. In our review of 503 consecutive children with meningitis, none were noted to have bacterial meningitis manifesting solely as a simple seizure. We suspect that this previously described entity is either extremely rare or nonexistent. Commonly taught decision rules requiring lumbar puncture in children with fever and a seizure appear to be unnecessarily restrictive.

Download Full-text

Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study

The Lancet Infectious Diseases ◽

10.1016/s1473-3099(16)30201-8 ◽

2016 ◽

Vol 16 (11) ◽

pp. 1279-1287 ◽

Cited By ~ 28

Author(s):

Natalie G Martin ◽

Mildred A Iro ◽

Manish Sadarangani ◽

Raphael Goldacre ◽

Andrew J Pollard ◽

...

Keyword(s):

Observational Study ◽

Hospital Admissions ◽

Population Based ◽

Viral Meningitis ◽

Meningitis In Children

Download Full-text

Lyme vs. Viral Meningitis in Children

Infectious Diseases in Clinical Practice ◽

10.1097/00019048-199911000-00002 ◽

1999 ◽

Vol 8 (8) ◽

pp. 359-360

Author(s):

Michael Barza

Keyword(s):

Viral Meningitis ◽

Meningitis In Children

Download Full-text

Role of Cerebrospinal Fluid - Adenosine Deaminase Level in Early diagnosis of Various Etiologies of Meningitis in children

Nepal Journal of Medical Sciences ◽

10.3126/njms.v1i2.6608 ◽

2012 ◽

Vol 1 (2) ◽

pp. 97-102 ◽

Cited By ~ 1

Author(s):

K Malla ◽

KS Rao ◽

T Malla ◽

J Vedamony ◽

P Ghimire

Keyword(s):

Cerebrospinal Fluid ◽

Early Diagnosis ◽

Adenosine Deaminase ◽

Predictive Value ◽

Viral Meningitis ◽

Clinical Findings ◽

Medical Sciences ◽

Tubercular Meningitis ◽

Meningitis In Children ◽

A Prospective Study

Background: Determination of cerebrospinal fluid-adenosine deaminase (CSF-ADA) activity is a reliable means to differentiate tubercular from non- tubercular meningitis. This study was carried out to see the range with mean CSF-ADA levels in meningitis of various etiologies and to see if early diagnosis is possible based on these levels. Methods: A prospective study of 140 children admitted in Manipal Teaching Hospital, from July 2009 – June 2011. Diagnosis was established by clinical findings and relevant investigations and patients were divided in different groups as pyogenic meningitis (PM), partially treated meningitis (PPM), tubercular meningitis (TBM), viral meningitis (VM) and controls. CSF-ADA estimation was done by using spectrophotometer. Results: Out of total 140 patients, 103 were cases of meningitis and 37 were controls. There were 32 cases of PM, 27 cases of PPM, 34 cases of VM and 10 cases of TBM. The mean±SD with range of CSF-ADA was respectively 48±20.37 IU/L (20-70 IU/L), 14.57±6.48 IU/L (2-28 IU/L), 6.40±2.17 IU/L (3-9 IU/L), 8.29±10 IU/L (3-11 IU/L) and 5.27±2.69 IU/L (2-7 IU/L) in TBM, PM, PPM, VM and controls and the value was highest in TBM. The specificity, sensitivity, positive predictive value and negative predictive value of CSF-ADA for TBM were 94.6%, 100 %, 83.3% and 100%. Conclusion: Estimation of ADA activity in CSF can be of great value in early diagnosis of tubercular meningitis. Furthermore it is a simple, reliable, relatively inexpensive test with easy procedure. DOI: http://dx.doi.org/10.3126/njms.v1i2.6608 Nepal Journal of Medical Sciences. 2012;1(2): 97-102

Download Full-text