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

One hundred and thirty-three children with suspected meningitis aged from 11 days to 16 years were investigated with routine cerebrospinal fluid (CSF) laboratory methods: microscopy of a Gram-stained smear, bacterial culture, determination of leukocytes, lactate, and the CSF/blood glucose ratio. On the basis of bacterial cultures and clinical course, the children were classified into three groups: bacterial meningitis (n = 18), aseptic meningitis (n = 28), and a control group (n = 87). The main intention was to study the relation between current diagnostic methods and lactate. CSF lactate levels and cell counts, related significantly (p less than 0.01) better to the presence of bacterial meningitis than CSF/blood glucose ratios. Lactate levels exceed 2.4 mmol/l in all children with bacterial meningitis, but in none of the control group. Of 28 children with aseptic meningitis 3 had lactate in the range 2.5-2.7 mmol/l, while the others had values of 2.4 mmol/l or less. We consider CSF lactate to be the best predictor in the clinical decision to institute antibiotic treatment of children with suspected bacterial meningitis.
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PMID:The diagnostic and predictive value of cerebrospinal fluid lactate in children with meningitis. Its relation to current diagnostic methods. 395 77

Viral meningitis is part of the aseptic meningitis syndrome but must be distinguished from bacterial meningitis on the basis of a careful examination of the CSF and sound clinical judgment. Enteroviruses probably account for the bulk of cases of aseptic meningitis that occur in the United States and which are reported to the Centers for Disease Control each year. The seasonal pattern in the incidence of aseptic meningitis is largely due to the seasonal variation of enteroviral infections. Early on, the CSF in patients with viral meningitis frequently contains a predominance of polymorphonuclear leukocytes and may even have a low glucose level. The presence of neutrophils in the initial CSF sample is especially common in patients with enteroviral infections. A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex. In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours. A shift from polymorphonuclear leukocytes to mononuclear cells makes viral meningitis the likely diagnosis. Both herpes simplex and varicella-zoster may infect the meninges by means of spread from cervical and dorsal root ganglia in a retrograde fashion much the way they spread in an antegrade fashion to the skin. HSV-2 is more likely to cause the clinical syndrome of viral meningitis, while HSV-1 is more likely to cause a meningoencephalitis with serious brain dysfunction. The identification of a specific viral agent in body fluids, especially the CSF, in a patient with aseptic meningitis is of more than academic interest, since it can shorten duration of hospital stay and eliminate unnecessary antimicrobial therapy. The diagnosis of enteroviral infections depends upon the isolation of a virus from CSF, stool, or throat plus a fourfold antibody response in the serum to the viral isolate. The 60-odd serotypes of enterovirus, each with different antigenic determinants, preclude serologic testing alone as a useful diagnostic test to identify the patient infected with coxsackievirus or echovirus. For infections, due to herpes simplex, varicella-zoster, LCM, and arboviruses, a serologic test alone can be useful.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Viral meningitis. 399 Apr 41

The fall in cerebrospinal fluid (CSF) glucose and CSF leukocyte response was studied in cats with experimental meningitis. Klebsiella pneumoniae or Streptococcus pneumoniae were injected intracisternally, and the latter organisms were incubated with CSF in vitro. When 10(6)-10(9)K. pneumoniae were incubated with 4 ml of CSF, the time time necessary for the glucose to decrease to less than 10 mg/dl ranged from 6.5 to 2.5 h, at a rate proportional to the size of the inoculum. When the same numbers of bacteria were injected intracisternally, the time ranged from 9 to 3 h, and the CSF leukocyte response did not exceed 1200 WBC/mm3. At this time, only minimal histological changes in brain and choroid plexus were seen. Twenty hours after intrathecal K. pneumoniae, large numbers of leukocytes (up to 4 X 10(4)/mm3) were recovered from the CSF. Regardless of the number of leukocytes, however, hypoglycorrhachia occurred when the CSF contained more than 10(7) bacteria/ml. At this interval, large numbers of leukocytes were seen invading the stroma of the choroid plexus, leptomeninges and perivascular spaces. When 10(8) S. pneumoniae were injected intracisternally, CSF glucose concentration decreased as rapidly as with K. pneumoniae. The spinal fluid leukocyte response to S. pneumoniae was, however, greater than that to K. pneumoniae. These results suggest that under the conditions of these studies, hypoglycorrhachia of bacterial meningitis is the result of metabolism of the bacteria with little contribution from the leukocytes.
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PMID:Cerebrospinal fluid glucose and leukocyte responses in experimental meningitis. 637 41

An association between hyperglycemia and mortality from cerebral ischemia has been reported in both animals and man. Recently, a similar observation has been made in animals with bacterial meningitis. The present study of 83 patients with bacterial meningitis showed no association between initial serum glucose concentration and subsequent mortality. Therefore, no therapeutic recommendations regarding optimal blood glucose levels in patients with meningitis can be made at this time.
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PMID:Hyperglycemia is not associated with mortality in bacterial meningitis. 661 75

The results of cerebrospinal fluid (CSF) examination and other initial laboratory investigations have been analysed in one hundred and forty-nine patients with meningitis. The CSF differential leucocyte count clearly distinguished between bacterial and viral meningitis in 92 per cent of patients evaluated: CSF glucose and protein concentrations were less predictive by comparison. CSF glucose values were particularly unreliable because of hyperglycaemia in patients with bacterial meningitis and predictive accuracy increased when CSF levels were expressed as a percentage of blood glucose concentration. Results were not influenced by the age of the patients, and laboratory evidence of bacterial infection did not appear to be masked by prior antimicrobial therapy. A management algorithm based on the results of initial tests was applied retrospectively to the patients in whom Gram-stained CSF did not reveal bacteria. The algorithm indicated immediate antimicrobial therapy for all thirty patients with pyogenic infections, and for only one of sixty-three patients with a final diagnosis of viral meningitis.
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PMID:The value of initial laboratory investigations in the management of meningitis. 663 Oct 27

The purpose of this study was to compare the ability of cerebrospinal fluid (CSF) concentrations of glucose, protein, chloride, lactate, and total amino acids, as well as CSF/blood glucose ratio to distinguish bacterial meningitis from aseptic meningitis. 56 patients with proven bacterial meningitis, 102 patients with aseptic meningitis, and 108 controls were investigated. On admission CSF lactate determination was the most sensitive and the most efficient test to distinguish bacterial meningitis from aseptic meningitis. In patients with bacterial meningitis reexamined after 24-48 h of treatment with antibiotics and compared with patients with aseptic meningitis also reexamined 24-48 h after admission determination of CSF total amino acids was the most sensitive and efficient test.
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PMID:Comparison between cerebrospinal fluid concentrations of glucose, total protein, chloride, lactate, and total amino acids for the differential diagnosis of patients with meningitis. 664 72

This review of 1,316 cases of purulent meningitis assessed changes in the etiology, clinical features, and fatality rate during the antibiotic era. Hemophilus influenzae was the most frequent cause of purulent meningitis (458 cases), Neisseria meningitidis the second most frequent (396 cases), and Streptococcus pneumoniae the third most frequent (178 cases). No bacterial etiology was found for 148 patients with purulent meningitis, the fourth major category of meningitis throughout the 23 years surveyed. Few patients had notable underlying diseases or predisposing conditions; 77.4% were less than 10 years old, but only 13 patients were less than one month old. Patients with meningitis caused by Staphylococcus aureus or various streptococci commonly had associated suppurative foci and the highest fatality rate. There were 103 deaths, of which 70.8% occurred during the first 48 hr of hospitalization. Antibiotics had been given to 54.6% of patients before admission to the hospital. Bacteriologic and cerebrospinal fluid (CSF) findings for patients who received antibiotics prior to admission ("pretreated") were compared with these findings for those who had not had antibiotics in 1,032 cases of meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae. No significant differences in white blood cell counts or in glucose or protein concentrations in CSF were noted among patients infected with any of the three organisms; positive cultures of blood and CSF were significantly less frequent in "pretreated" patients whose disease was caused by any of the three organisms, and particularly in those with meningitis due to N. meningitidis. Nasopharyngeal, throat, and rectal swabs and CSF specimens from 141 patients were cultured for virus. Enteroviruses were isolated from rectal swabs of two patients with bacterial meningitis and from the CSF of two patients (in mixed culture with Salmonella enteritidis in one case).
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PMID:Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976. 676 3

The major causative agents of bacterial meningitis (Haemophilus influenzae serogroup B, Neisseria meningitidis serogroups B and C, Klebsiella pneumoniae, Steptococcus pneumoniae, and two types of Escherichia coli) were cultured in a chemically defined medium, and selected strains were further studied in Todd-Hewitt medium. After acidic extraction of the spent media with chloroform, a basic extraction was made with chloroform to obtain amines. A third extraction was performed on re-acidified Todd-Hewitt medium with ethyl ether to obtain hydroxyacids. The extracts were derivatized with heptafluorobutyric anhydride-ethanol to form electron-capturing derivatives, and the derivatives were analyzed on a frequency-pulsed electron capture gas-liquid chromatograph (FPEC-GLC) equipped with a PEP-2 computer. The data obtained from the study showed that amines were produced by these organisms that formed characteristic patterns. Different serotypes of K. pneumoniae and the two serogroups of N. meningitidis produced different types of FPEC-GLC profiles within serotypes. E. coli produced several hydroxy acids on Todd-Hewitt medium that made it unique among the organisms studied. The methods used are practical and the techniques have potential for use in clinical laboratories and hospitals as a valuable aid for the rapid identification of the major causative agents of bacterial meningitis.
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PMID:Rapid differentiation of the major causative agents of bacterial meningitis by use of frequency-pulsed electron capture gas-liquid chromatography: analysis of amines. 676 64

Cerebrospinal fluid with a normal cell count, glucose and protein values, and a negative Gram's stain smear is usually assumed to exclude the possibility of meningitis. We describe four patients and review from literature 19 patients with pyogenic meningitis in whom the CSF initially appeared normal. Thus, finding minimal or no initial CSF abnormality is consistent with early or developing bacterial meningitis. Repeated lumbar puncture and CSF examination within 24 hours should be considered in all febrile patients in whom the clinical features remain compatible with meningitis.
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PMID:'Normal' CSF in bacterial meningitis. 677 95

Severe acute meningitis developed after the use of metrizamide for lumbar myelography; cerebrospinal fluid findings included a white blood cell count of 2300, mostly polymorphonuclear cells, glucose level of 8 mg% and protein level of 253%. This apparent chemical meningitis could not be distinguished, either clinically or by cerebrospinal fluid examination, from acute bacterial meningitis. This case emphasizes that severe acute meningeal reactions, while very rare, can occur after the use of metrizamide for myelography. Such patients must be evaluated promptly to rule out bacterial meningitis and should be followed carefully for possible later sequelae.
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PMID:Acute chemical meningitis after metrizamide-lumbar myelography. 684 60


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