Meningitis In Emergency Department Research Articles

Validation of the Bacterial Meningitis Score in adults consulting at an emergency department: a retrospective multicentric study.

The Bacterial Meningitis Score (BMS) is recommended by pediatric academic societies to rule out the diagnosis of bacterial meningitis. The aim of this study was to evaluate the performance of the BMS to identify adults at no risk for bacterial meningitis. We conducted a multicentric retrospective study including adults who consulted the emergency department (ED) for meningitis [cerebrospinal fluid (CSF) white blood cells ≥5/mm with a ratio of white blood cells/red blood cells <1:900) during a 4-year period. The BMS variables were: CSF positive Gram stain, CSF absolute neutrophil count ≥1000 cells/μL, CSF protein ≥80 mg/dL, peripheral blood absolute neutrophil count ≥10 000 cells/μL, and seizures. Bacterial meningitis was defined for patients who had a lumbar puncture with CSF pleocytosis and positive bacterial analysis of CSF. The primary endpoint was the sensitivity of the BMS to rule out bacterial meningitis in adults. The secondary outcome was to assess the rate of patients for whom antibiotics could have been avoided using the BMS and the diagnostic performance of procalcitonin in patients with a BMS ≥1. Of 930 patients with meningitis, 626 were included in the analysis, and 27 (4.3%) were diagnosed with bacterial meningitis. A total of 384/626 (61.3%) patients had a BMS = 0, and none presented bacterial meningitis. BMS sensitivity was 100% [95% confidence interval (CI), 87.2-100%], and its negative predictive values were 100% (95% CI, 98.8-100%). Among patients with a diagnosis of meningitis in ED, a BMS of 0 may safely rule out bacterial meningitis.

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Background and aims: Globally, meningitis can lead to a high rate of death and disability in children. Aims: Our aim was to assess the clinical and laboratory features of children with a diagnosis of meningitis in emergency department. Methods: The children admitted to the emergency department with clinically suspected of meningitis and with abnormal cerebrospinal fluid findings (CSF: ≥ 10 WBC per mm3) was included the study. Bacterial meningitis was considered if any following criteria were met in a child with positive CSF culture or positive gram stain. The WHO definition for probable meningitis (CSF with ≥ 100 WBC per mm3, 10–99 WBC per mm3 plus protein concentration ≥100 mg/dL or glucose <40 mg/dL) and high Bacterial Meningitis Score (high BMS= CSF ≥ 10 WBC per mm3 with positive gram stain, CSF neutrophil count ≥ 1000 cells/ mm3, CSF protein ≥100 mg/dL or seizure before or at presentation) were used. Results: A total of 190 children with abnormal CSF findings were included the study. They were classified as aseptic (171, 90%) and bacterial (19, 10%) meningitis. Bulging fontanelle and headache were more common in bacterial meningitis group (p<0.05). Blood procalcitonin levels were higher and CSF glucose levels were lower in bacterial meningitis group (p<0.05). The rate of probable meningitis and high BMS were not different in the groups (p>0.05). In logistic regression analysis, there was no significant parameter for bacterial meningitis diagnosis (p<0.05). Conclusions: Signs, symptoms, proposed criteria for high suspicion of bacterial meningitis, and laboratory findings at admission are not helpful for diagnosis of bacterial meningitis.

Three Cases of Neoplastic Meningitis Initially Diagnosed with Infectious Meningitis in Emergency Department

Neoplastic meningitis (NM) is diagnosed by the presence of malignant cells in the cerebrospinal fluid (CSF). We report 3 patients with NM, who were misdiagnosed with infectious meningitis in emergency department (ED). Case 1. A 68-year-old man visited our ED with a 3-month history of headache. With MRI and CSF study, he was diagnosed with tuberculous meningitis. After 20 days, repeated CSF cytology showed malignant cells. His diagnosis was lung cancer with NM. Case 2. A 57-year-old man visited regional hospital ED with a 3-week history of headache and diplopia. Brain MRI was not contributory. With CSF examination, his diagnosis was aseptic meningitis. With worsening headache, he was referred to our ED. Repeated CSF showed malignant cells. His diagnosis was stomach cancer with NM. Case 3. A 75-year-old man visited a regional hospital with headache lasting for 4 months. His diagnosis was sinusitis. Persistent symptom brought him back, and he developed recurrent generalized seizures. Brain MRI showed diffuse leptomeningeal enhancement suggesting meningitis, and he was transferred to our ED. CSF exam showed malignant cells. His diagnosis was NM with unknown primary focus. When evaluating the patients with headache in ED, NM should be kept in mind as a differential diagnosis of meningitis.