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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical diagnosis of acute bacterial meningitis may be delayed, either because off lack of sensitivity of clinical signs, or because of a poor vital prognosis; but over diagnosing is also frequent, leading to useless, expensive, and potentially dangerous hospitalizations. We conducted a comprehensive review of English and French literature from 1997 to 2007 by searching MEDLINE to review the accuracy of clinical examination for the diagnosis of meningitis. Additional references were identified by reviewing reference lists of articles back to 1993. We used the keywords "meningitis", "meningitis and clinical features", "cerebrospinal fluid (CSF) pleocytosis", "headache and fever", "Kernig sign", "Brudzinski sign", and "neck stiffness". We excluded nosocomial meningitis. Sensitivity for clinical signs such as headache, vomiting, or fever was low, generally less than 30%, neck stiffness could reach 45%, but the absence of two signs among fever, headache, neck stiffness, and altered mental status eliminated meningitis with a negative predictive value of 95%. Given the seriousness of bacterial meningitis, clinicians perform lumbar puncture (or brain imaging) too often, especially in high-risk patients. Further prospective clinical research is needed to improve the accuracy of bacterial meningitis clinical diagnosis.
Med Mal Infect
PMID:[Sensitivity and specificity of clinical signs in adults]. 1963 74

An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection.
Med Mal Infect 2012 Dec
PMID:[Group A streptococcal meningitis]. 2310 29


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