SIX RULES TO DISTINGUISH BETWEEN BACTERIAL AND 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

Cerebrospinal fluid ferritin and albumin index: potential candidates for scoring system to differentiate between bacterial and viral meningitis in children

Biomarkers ◽

10.3109/1354750x.2016.1148777 ◽

2016 ◽

Vol 21 (5) ◽

pp. 424-428 ◽

Cited By ~ 3

Author(s):

Angelin A. Jebamalar ◽

Agiesh K. Balakrishnapillai ◽

Narayanan Parmeswaran ◽

Pooja Dhiman ◽

Soundravally Rajendiran

Keyword(s):

Cerebrospinal Fluid ◽

Scoring System ◽

Viral Meningitis ◽

Meningitis In Children

Download Full-text

Procalcitonin as a Serum Biomarker for Differentiation of Bacterial Meningitis From Viral Meningitis in Children

Clinical Pediatrics ◽

10.1177/0009922815606414 ◽

2015 ◽

Vol 55 (8) ◽

pp. 749-764 ◽

Cited By ~ 17

Author(s):

Brandon Michael Henry ◽

Joyeeta Roy ◽

Piravin Kumar Ramakrishnan ◽

Jens Vikse ◽

Krzysztof A. Tomaszewski ◽

...

Keyword(s):

Likelihood Ratio ◽

Pediatric Patients ◽

Meta Analysis ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Viral Meningitis ◽

Meningitis In Children ◽

Viral Etiologies

Several studies have explored the use of serum procalcitonin (PCT) in differentiating between bacterial and viral etiologies in children with suspected meningitis. We pooled these studies into a meta-analysis to determine the PCT diagnostic accuracy. All major databases were searched through March 2015. No date or language restrictions were applied. Eight studies (n = 616 pediatric patients) were included. Serum PCT assay was found to be very accurate for differentiating the etiology of pediatric meningitis with pooled sensitivity and specificity of 0.96 (95% CI = 0.92-0.98) and 0.89 (95% CI = 0.86-0.92), respectively. The pooled positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and area under the curve (AUC) for PCT were 7.5 (95% CI = 5.6-10.1), 0.08(95% CI = 0.04-0.14), 142.3 (95% CI = 59.5-340.4), and 0.97 (SE = 0.01), respectively. In 6 studies, PCT was found to be superior than CRP, whose DOR was only 16.7 (95%CI = 8.8-31.7). Our meta-analysis demonstrates that serum PCT assay is a highly accurate and powerful test for rapidly differentiating between bacterial and viral meningitis in children.

Download Full-text