Abstract
ABSTRACTObjective: To evaluate Bacterial Meningitis Score (BMS) on its own and in association with Cerebrospinal Fluid (CSF) lactate dosage in order to distinguish bacterial from aseptic meningitis.Methods: Children diagnosed with meningitis at a tertiary hospital between January/2011 and December/2014 were selected. All data were obtained upon admission. BMS was applied and included: CSF Gram staining (2 points); CSF neutrophil count ≥1,000 cells/mm3 (1 point); CSF protein ≥80 mg/dL (1 point); peripheral blood neutrophil count ≥10,000 cells/mm3 (1 point) and seizures upon/before arrival (1 point). Cutoff value for CSF lactate was ≥30 mg/dL. Sensitivity, specificity and negative predictive value of several BMS cutoffs and BMS associated with high CSF lactate were evaluated for prediction of bacterial meningitis.Results: Among 439 eligible patients, 94 did not have all data available to complete the score, and 345 patients were included: 7 in bacterial meningitis group and 338 in aseptic meningitis group. As predictive factors of bacterial meningitis, BMS ≥1 had 100% sensitivity (95%CI 47.3-100), 64.2% specificity (58.8-100) and 100% negative predictive value (97.5-100); BMS ≥2 or BMS ≥1 associated with high CSF lactate also showed 100% sensitivity (47.3-100); but 98.5% specificity (96.6-99.5) and 100% negative predictive value (98.3-100).Conclusions: 2 point BMS in association with CSF lactate dosage had the same sensitivity and negative predictive value, with increased specificity for diagnosis of bacterial meningitis when compared with 1-point BMS.
Highlights
Upon initial care of children with meningitis, distinction between bacterial and aseptic forms is fundamental.[1]
The microorganisms isolated in cultures of patients in bacterial meningitis (BM) group were: Streptococcus pneumoniae, Neisseria meningitidis, and Enterococcus faecalis
When analyzing 1-point Bacterial Meningitis Score (BMS) predictive value for BM, results were 100% sensitivity and negative predictive value, but specificity was low (64.2%), which is in accordance with what has already been reported by other authors.[11,12,13,14,15]
Summary
Upon initial care of children with meningitis, distinction between bacterial and aseptic forms is fundamental.[1] For bacterial meningitis (BM), the immediate course of antibiotic therapy and hospitalization are paramount, whereas in aseptic meningitis (AM, usually viral) only supportive measures are necessary.[1,2,3,4,5,6,7] this distinction is not always easy in daily practice, especially in cases of viral meningitis with predominance of neutrophils in first cerebrospinal fluid (CSF) collection For this reason, many children with viral meningitis are hospitalized and receive antibiotics treatment until cultures are assessed, which may take a few days.[8,9,10] As there is a need to reduce hospitalizations and the unnecessary use of antibiotics, two scores were proposed: Bacterial Meningitis Score (BMS) was proposed by Nigrovic et al.[11] and has shown sensitivity and negative predictive value close to 100%; Meningitest, proposed by European authors,[12] was shown to be less specific when compared BMS. If all of them test negative, sensitivity and negative predictive value to rule out BM are 100%.11
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