Meningococcal meningitis with ‘normal’ cerebrospinal fluid

doi:10.1016/S0163-4453(94)91197-5

Journal of Infection

Volume 29, Issue 3, November 1994, Pages 289-294

https://doi.org/10.1016/S0163-4453(94)91197-5 Get rights and content

Summary

A prospective study was made of all patients with normal CSF counts and positive cultures for Neisseria meningitidis diagnosed in “El Vallés” County, Barcelona between January 1987 and December 1990. Meningococcal meningitis was documented in 82 patients, eight of whom (seven children, five boys and two girls with a mean age of 5·6 ± 3·3 years, and a 69-year-old male patient) had no apparent CSF abnormalities in the initial lumbar puncture. At the time of admission all patients had fever (mean 39·1 °C) of 10·8 ± 5·6 hour duration and petechial rash which had been present for a mean of 3·6 ± 3·3 hours. Signs of meningeal irritation were not found. A 4-month-old infant with symptoms of circulatory collapse, intracranial hypertension and impairment of consciousness subsequently died of septicemia in 48 hours. Group B N. meningitidis was isolated in six cases (reduced penicillin-susceptibility in two cases) and group C N. meningitidis in the remaining two (reduced penicillin-susceptibility in one case). Patients without pleocytosis did not differ in a statistically significant fashion from the patients with high pleocytosis in the duration of temperature, and petechial rash, leukopenia, positive blood culture and fatal outcome.

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Pneumococcal meningitis remains the most common cause of bacterial meningitis in children globally, contributing significantly to childhood morbidity and mortality. In countries where they are used, multi-valent vaccines have reduced the incidence of pneumococcal meningitis over time and altered the predominant serovars and epidemiology. Changing global antimicrobial resistance patterns of invasive Streptococcus pneumoniae have also been observed over time. This article considers current epidemiology and management of pneumococcal meningitis within this shifting landscape and offers practical advice to healthcare professionals working with children and young people.
Management of acute community-acquired bacterial meningitis (excluding newborns). Short text
2019, Medecine et Maladies Infectieuses
Citation Excerpt :
Results should be put into perspective with the other clinical, biological (CSF and serum), and microbiological results. This approach is complicated by the various clinical situations, especially when the lumbar puncture or antibiotic therapy has been performed or initiated early on [14,15]. Microbiological examination following Gram staining is rapid and easy to perform.
CSF in acute and chronic infectious diseases
2017, Handbook of Clinical Neurology
Infections of the nervous system are an important and challenging aspect of clinical neurology. Immediate correct diagnosis enables to introduce effective therapy, in conditions that without diagnosis may leave the patient with severe neurological incapacitation and sometimes even death. The cerebrospinal fluid (CSF) is a mirror that reflects nervous system pathology and can promote early diagnosis and therapy. The present chapter focuses on the CSF findings in neuro-infections, mainly viral and bacterial. Opening pressure, protein and glucose levels, presence of cells and type of the cellular reaction should be monitored. Other tests can also shed light on the causative agent: serology, culture, staining, molecular techniques such as polymerase chain reaction. Specific examination such as panbacterial and panfungal examinations should be examined when relevant. Our chapter is a guide-text that combines clinical presentation and course with CSF findings as a usuaful tool in diagnosis of neuroinfections.
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Isolation of bacterial cerebrospinal fluid culture contaminants at a major military medical center
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These false-positive (FP) CSF culture rates range from 2.7% to 8.3% in institution-based reports (Dunbar et al., 1998; Lessing & Bowler, 1996; Olson & Hoeprich, 1984). Further complicating the diagnosis is the fact that cases of true bacterial meningitis with normal CSF parameters have also been well documented (Araj et al., 1993; Coll et al., 1994; Onorato et al., 1980; Ray & Rylance, 2009; Rebeu-Dartiguelongue et al., 2005). However, outside of isolated case reports, few large studies reference cases in which normal CSF parameters contradict the clinical context, nor does the current literature suggest guidelines to assist in interpreting the significance (or lack thereof) of such findings.
In recent decades, bacterial meningitis rates have decreased secondary to the success of routine vaccinations. Ironically, the decreased incidence may contribute to the challenge of establishing accurate and timely diagnoses. Studies have suggested that in immunocompetent patients with normal cerebrospinal fluid (CSF) white blood cell counts (WBC), positive CSF cultures may be disregarded as presumed contaminants, making the initial CSF WBC increasingly relevant. This single-institution retrospective study sought to integrate clinical data with positive cultures in an era when CSF contaminants may be more commonly isolated in culture than true pathogens. A total of 7715 adult and pediatric CSF samples from 1995 to 2009 were obtained at a major military medical center. Clinical and laboratory data from 121 positive bacterial cultures were reviewed. Our bacterial CSF contamination rate (false positives) was 0.91% (70/7715). True-positive (TP) CSF cultures totaled 51 (0.66%). Among TPs, 16% (8/51) demonstrated normal CSF cell counts. The notably low 15-year CSF contamination rate of 0.91%, suggests that positive cultures are likely to represent true infection in our institution. We believe efforts to decrease the contamination rate are among the most cost-effective, while targeted clinical re-evaluation for all patients with positive CSF cultures remains vital. In light of this data, a targeted approach to re-evaluating positive cultures while incorporating the clinical context remains prudent.
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Journal of Infection

Summary

References (14)

Normal cerebrospinal fluid values in children: another look

Pediatrics

Report of the Task Force on diagnosis and management of meningitis

Pediatrics

‘Normal’ CSF in bacterial meningitis

JAMA

Bacterial meningitis presenting with normal cerebrospinal fluid

Pediatr Infect Dis J

Difficulties in diagnosing meningococcal meningitis in children

BMJ

Absent or minimal cerebrospinal fluid abnormalities in Haemophilus influenzae meningitis

Pediatr Emerg Care

Bacterial meningitis in children whose cerebrospinal fluid contains polymorphonuclear leukocytes without pleocytosis

Clin Pediatr

Cited by (50)

Pneumococcal meningitis in children

Management of acute community-acquired bacterial meningitis (excluding newborns). Short text

CSF in acute and chronic infectious diseases

Acute Meningitis

Isolation of bacterial cerebrospinal fluid culture contaminants at a major military medical center

Tuberculous meningitis hydrocephalus with normal ventricular cerebrospinal fluid

Original articleMeningococcal meningitis with ‘normal’ cerebrospinal fluid

Summary

Normal cerebrospinal fluid values in children: another look

Pediatrics

Report of the Task Force on diagnosis and management of meningitis

Pediatrics

‘Normal’ CSF in bacterial meningitis

JAMA

Bacterial meningitis presenting with normal cerebrospinal fluid

Pediatr Infect Dis J

Difficulties in diagnosing meningococcal meningitis in children

BMJ

Absent or minimal cerebrospinal fluid abnormalities in Haemophilus influenzae meningitis

Pediatr Emerg Care

Bacterial meningitis in children whose cerebrospinal fluid contains polymorphonuclear leukocytes without pleocytosis

Clin Pediatr

Original article
Meningococcal meningitis with ‘normal’ cerebrospinal fluid