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

A retrospective study was performed of 32 bacteremic children not receiving preadmission antibiotic therapy who had a diagnostic lumbar puncture for analysis of cerebrospinal fluid at the time of initial evaluation for an acute illness. In each instance, the CSF contained polymorphonuclear leukocytes without pleocytosis. Of these 32 bacteremic patients, 88% had a CSF differential cell count with 20% or fewer polymorphonuclear cells, and greater than 90% had glucose and protein concentration within the range of normal limits. All patients had a Gram-stained smear of CSF which revealed no organisms. In no instance was a CSF culture positive for a bacterial pathogen. In the bacteremic child not pretreated with antibiotics, cerebrospinal fluid which contains total white blood cell, glucose, and protein concentrations within limits of normal, a differential cell count with 20% or fewer polymorphonuclear leukocytes, and Gram-stained smear which reveals no organisms is not indicative of risk for bacterial meningitis.
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PMID:Significance of polymorphonuclear leukocytes in CSF of bacteremic children. 318 21

The performance of lumbar puncture (LP) in patients with suspected meningitis is often delayed if, for example, the clinical presentation suggests a need for prior computed tomographic (CT) scan or if patients are initially examined at settings with limited clinical facilities. The role of empiric parenteral antibiotic therapy prior to LP under these circumstances has not been critically analyzed. Review of the literature suggests that in cases of bacterial meningitis (1) the existing data are inadequate to assess the effect of a short delay of therapy on mortality and morbidity; (2) a short period of antibiotic therapy prior to LP does not change cerebrospinal fluid (CSF) white blood cell count, protein, or glucose; (3) the yield of CSF gram stain and culture may be somewhat reduced by a short period of antibiotic therapy, but these tests often remain positive; and (4) adjunctive tests, including blood cultures and CSF antigen tests, can often independently identify the bacterial meningopathogen. The available evidence suggests that if bacterial meningitis is suspected and LP must be delayed, intravenous antibiotics are warranted before CSF is obtained.
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PMID:Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. 236 55

A retrospective study was performed of 424 children who received diagnostic lumbar puncture for analysis of cerebrospinal fluid during evaluation of an acute illness. In 106 children, the CSF contained polymorphonuclear leukocytes without pleocytosis. Of these 106 patients, 90 percent had a CSF differential cell count with 20 percent or less PMN's and 88 percent had glucose and protein concentrations within the range of normal limits. All patients had a Gram-stained smear of CSF that revealed no organisms. In no instance was a CSF culture positive for a bacterial pathogen. In most instances, cerebrospinal fluid that contains total white cell count and glucose/protein concentrations within limits of normal, Gram-stained smear which reveals no organisms, and a differential cell count with less than 20 percent PMN's is not indicative of risk for bacterial meningitis. If the clinical situation warrants, the majority of children with this profile do not require hospitalization and initiation of empiric antibiotic therapy pending CSF culture results.
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PMID:Bacterial meningitis in children whose cerebrospinal fluid contains polymorphonuclear leukocytes without pleocytosis. 334 29

Usefulness of cell count and concentrations of glucose and total protein in CSF are analysed with regard to the diagnosis of leptomeningeal metastasis from solid and hematological malignancy. A group of patients with pleiocytosis in CSF of non-neoplastic origin served as a reference group. It is concluded that these routine tests have limited value for the determination of the viral, bacterial or neoplastic etiology of meningeal disorders. The most important value of these tests appears to be the discriminating capacity of the finding of an increased number of polymorphonuclear leucocytes, regularly found in patients with acute bacterial meningitis.
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PMID:Routine investigations of the CSF with special reference to meningeal malignancy and infectious meningitis. 337 45

The stress response in humans commonly includes elevations in plasma concentrations of glucocorticoids, catecholamines, glucagon, growth hormone, aldosterone, and renin, resulting in alterations in the metabolism of glucose and other energy substrates, and in increased sodium and water retention. In severe illness, triiodothyronine and sometimes thyroxine are decreased without evidence of clinical hypothyroidism. Antidiuretic hormone may be elevated in bacterial meningitis and other central nervous system disorders, as well as in acute asthma, chronic ventilator therapy, pneumothorax, atelectasis, and postoperatively. Increased ADH concentration can lead to significant hypoosmolality and hyponatremia with adverse effects on the patient. In the setting of severe intracerebral insults, ADH may be inappropriately low, resulting in diabetes insipidus. Insulin concentrations may be inappropriately low for serum glucose concentration, or insulin may have diminished receptor responsiveness in seriously stressed patients. Either situation leads to hyperglycemia. Disturbances in calcium, phosphorus, and magnesium homeostasis may occur relatively frequently in the critically ill patient in response to therapeutic interventions, or illness-induced altered metabolism. It is not always clear when an altered metabolic or hormonal state is an appropriate response to a stress, or represents decompensation of the body's mechanisms for coping with that stress. It is important, however to recognize the common responses of the organism to severe illness, and to monitor for treatable abnormalities which occur.
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PMID:Endocrine manifestations of critical illness in the child. 354 20

Contamination of cerebrospinal fluid (CSF) with blood was studied prospectively in nine children with aseptic meningitis as the second phase of a study reported in this volume last month. Using criteria defined in the first phase, four of nine patients had recognizably abnormal CSF after experimental contamination with blood. As a third phase of the study, 53 children with bacterial meningitis were reviewed retrospectively to assess if hypothetical contamination of CSF with blood would have disguised their abnormal CSF studies. All but one of these 53 patients had either an abnormal CSF glucose or a positive gram stain (indicators independent of contamination with blood), and none would have gone undiagnosed with hypothetical contamination of up to 200,000 red cells per cubic millimeter. Guidelines for interpretation of laboratory studies following traumatic lumbar puncture are reviewed.
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PMID:Interpretation of traumatic lumbar puncture. Predictive value in the presence of meningitis. 376 75

We examined the diagnostic value of C-reactive protein (CRP) in cerebrospinal fluid (CSF) on initial lumbar puncture in a prospective study including 126 patients (30 neonates, 96 infants and children) suspected of having meningitis. Twenty patients were considered to have bacterial and 25 were considered to have viral meningitis. In infants and children, a retrospectively chosen cut-off CRP titre of 4 (i.e. approximately equal to 0.4 mg/l CRP) had a sensitivity of 100% and a specificity of 94% for differentiating bacterial meningitis from both viral meningitis and normal. It was a more sensitive and selective test for differentiating bacterial from viral meningitis on initial CSF examination than was the CSF leucocyte count, glucose concentration or protein concentration. In neonates, no such cut-off CRP titre could be found, presumably due to the immaturity of the blood-CSF-barrier (B1-CSF-B) during the first weeks of life. In a parallel study including a non-selected group of 13 infants and children (4 without, 9 with bacterial meningitis), the serum/CSF CRP concentration ratios were determined and inserted in the individual B1-CSF-B diagrams according to Felgenhauer. The results were fully consistent with the hypothesis that the CRP concentration in CSF reflects the normal permeability characteristics of the B1-CSF-B, or the degree of its impairment. Based on our results, we recommend the CSF CRP estimation in the routine evaluation of infants and children suspected of having meningitis.
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PMID:Cerebrospinal fluid C-reactive protein in meningitis: diagnostic value and pathophysiology. 376 91

Auditory brainstem responses were measured in 94 children under 24 months of age immediately following treatment for bacterial meningitis. Evidence of peripheral hearing loss (thresholds of 30 dB HLn or greater) was found in 47% of the patients. In addition, 9% had prolonged interwave latencies, indicating the possible presence of retrocochlear pathology. Other clinical data were examined as well. CSF glucose concentration correlated with both the presence and magnitude of hearing loss (as measured by auditory brainstem responses). Magnitude of hearing loss also was associated with the presence of seizures. Although all children recovering from meningitis should be assessed for hearing loss, those who have had low CSF glucose concentrations and seizures appear to be at high risk.
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PMID:Cerebrospinal fluid parameters and auditory brainstem responses following meningitis. 388 Mar 98

Samples of cerebrospinal fluid from 112 cases of suspected meningitis were tested for the presence of C-reactive protein (CRP), using a qualitative and quantitative slide test. Bacterial meningitis was confirmed in 34 patients, based on CSF and blood culture results, and/or elevated CSF white blood cell (WBC) count and typical biochemical profile. There were 8 patients with early onset, and 3 who had received prior antimicrobial therapy among the 5 neonates, 23 children, and 6 adults with bacterial meningitis. Organisms recovered from CSF, and/or blood, included Haemophilus influenzae 14, Streptococcus pneumoniae 9, Streptococcus group B-5, Staphylococcus aureus 2, E. coli 2 and Klebsiella pneumoniae 1. Slide test was positive for CRP in 33 cases, giving a sensitivity of 97% which compared favourably with elevated CSF protein 33%, decreased CFS glucose 64.7% CSF glucose/blood glucose less than 1/2, 85%, raised CSF WBC 38.2%, raised CSF PMN 61.7%, CSF culture positive 88.2%, and CSF gram-positive 82.5%. Slide test was positive for CRP in 1 of 78 CSF samples negative for bacterial meningitis, giving a specificity of 98%. It was concluded that testing of CSF for CRP is a simple, rapid and accurate method for the laboratory diagnosis of bacterial meningitis, which is particularly appropriate for areas lacking adequate laboratory facilities.
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PMID:Cerebrospinal fluid C-reactive protein in the laboratory diagnosis of bacterial meningitis. 389 17

The value of cerebrospinal fluid (CSF) lactate and lactate dehydrogenase (LD) activity in the rapid diagnosis of meningitis was investigated in three groups of patients--a 'no meningitis', an aseptic meningitis and a bacterial meningitis group. The sensitivity achieved in the detection of bacterial meningitis by CSF lactate values of 2.85 mmol/l (93.8%) and 3.9 mmol/l (89.6%) was greater than that reached by conventional chemical investigations using a CSF protein value of 1 g/l (81.5%) or a CSF glucose value of 2.2 mmol/l (68.8%) as the indicator. The sensitivity of an absolute CSF LD value of 40 U/l (86.3%) in the detection of bacterial meningitis was slightly lower than that of a CSF protein value of 1 g/l (87%) and better than the sensitivity of either a CSF/serum LD ratio of 0.1:1.0 (83.9%) or a CSF glucose level of 2.2 mmol/l (76.3%). As with conventional CSF chemistry, both investigations may give normal values in the presence of bacterial meningitis.
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PMID:Cerebrospinal fluid lactate and lactate dehydrogenase activity in the rapid diagnosis of bacterial meningitis. 394 41


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