Prevalence Of Bacterial Meningitis Research Articles

Evaluation of patients presenting with febrile seizures in an Iranian referral hospital: emphasis on the frequency of meningitis and co-infections

IntroductionFebrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures.MethodsThis retrospective cross-sectional study was conducted at the Children’s Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients’ data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases.The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated.ResultsA total of 290 patients were referred to the Children’s Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination.ConclusionEvaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure.

Prevalence of Bacterial Meningitis in Children with Apparent Febrile Convulsion

Prevalence of Bacterial Meningitis in Children with Apparent Febrile Convulsion

Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results.

To determine the prevalence of bacteremia and/or bacterial meningitis in febrile infants ≤60 days of age with positive urinalysis (UA) results. Secondary analysis of a prospective observational study of noncritical febrile infants ≤60 days between 2011 and 2019 conducted in the Pediatric Emergency Care Applied Research Network emergency departments. Participants had temperatures ≥38°C and were evaluated with blood cultures and had UAs available for analysis. We report the prevalence of bacteremia and bacterial meningitis in those with and without positive UA results. Among 7180 infants, 1090 (15.2%) had positive UA results. The risk of bacteremia was higher in those with positive versus negative UA results (63/1090 [5.8%] vs 69/6090 [1.1%], difference 4.7% [3.3% to 6.1%]). There was no difference in the prevalence of bacterial meningitis in infants ≤28 days of age with positive versus negative UA results (∼1% in both groups). However, among 697 infants aged 29 to 60 days with positive UA results, there were no cases of bacterial meningitis in comparison to 9 of 4153 with negative UA results (0.2%, difference -0.2% [-0.4% to -0.1%]). In addition, there were no cases of bacteremia and/or bacterial meningitis in the 148 infants ≤60 days of age with positive UA results who had the Pediatric Emergency Care Applied Research Network low-risk blood thresholds of absolute neutrophil count <4 × 103 cells/mm3 and procalcitonin <0.5 ng/mL. Among noncritical febrile infants ≤60 days of age with positive UA results, there were no cases of bacterial meningitis in those aged 29 to 60 days and no cases of bacteremia and/or bacterial meningitis in any low-risk infants based on low-risk blood thresholds in both months of life. These findings can guide lumbar puncture use and other clinical decision making.

Value of Temperature for Predicting Invasive Bacterial Infection in Febrile Infants: A Spanish Pediatric Emergency Research Group (RISeuP-SPERG) Study.

This study aimed to analyze the prevalence of invasive bacterial infection (IBI) among infants younger than 90 days with fever without source according to the degree of fever. We performed a secondary analysis of a multicenter study with 19 participating Spanish pediatric emergency departments that included 3401 febrile infants 90 days or younger. Prevalence of IBI was 3.2% (5.3% among infants <29 days old, 2.5% among those 29-60 days old, and 2.2% among those 61-90 days old). Prevalence of bacteremia increased with the degree of fever, meanwhile the prevalence of bacterial meningitis did not. No cutoff point was useful for ruling out an IBI safely. Overall, 46.7% of the IBIs were diagnosed in patients with temperature <38.6° (sensitivity, 53.3%; negative likelihood ratio, 0.81). Performing blood tests should be recommended in infants 90 days or younger with temperature ≥38°C without source regardless of the degree of fever.

Prevalence of Bacterial Meningitis Among Febrile Infants Aged 29-60 Days With Positive Urinalysis Results

Fever in the first months of life remains one of the most common pediatric problems. Urinary tract infections are the most frequent serious bacterial infections in this population. All published guidelines and quality initiatives for febrile young infants recommend lumbar puncture (LP) and cerebrospinal fluid (CSF) testing on the basis of a positive urinalysis result to exclude bacterial meningitis as a cause. For well infants older than 28 days with an abnormal urinalysis result, LP remains controversial. To assess the prevalence of bacterial meningitis among febrile infants 29 to 60 days of age with a positive urinalysis result to evaluate whether LP is routinely required. MEDLINE and Embase were searched for articles published from January 1, 2000, to July 25, 2018, with deliberate limitation to recent studies. Before analysis, the search was repeated (October 6, 2019) to ensure that new studies were included. Studies that reported on healthy, full-term, well-appearing febrile infants 29 to 60 days of age for whom patient-level data could be ascertained for urinalysis results and meningitis status were included. Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the Newcastle-Ottawa Scale to assess bias. Pooled prevalences and odds ratios (ORs) were estimated using random-effect models. The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with positive urinalysis results. The secondary outcome was the prevalence of bacterial meningitis, defined by CSF testing or suggestive history at clinical follow-up. The parent search yielded 3227 records; 48 studies were included (17 distinct data sets of 25 374 infants). The prevalence of culture-proven meningitis was 0.44% (95% CI, 0.25%-0.78%) among 2703 infants with positive urinalysis results compared with 0.50% (95% CI, 0.33%-0.76%) among 10 032 infants with negative urinalysis results (OR, 0.74; 95% CI, 0.39-1.38). The prevalence of bacterial meningitis was 0.25% (95% CI, 0.14%-0.45%) among 4737 infants with meningitis status ascertained by CSF testing or clinical follow-up and 0.28% (95% CI, 0.21%-0.36%) among 20 637 infants with positive and negative urinalysis results (OR, 0.89; 95% CI, 0.48-1.68). In this systematic review and meta-analysis, the prevalence of bacterial meningitis in well-appearing febrile infants 29 to 60 days of age with positive urinalysis results ranged from 0.25% to 0.44% and was not higher than that in infants with negative urinalysis results. These results suggest that for these infants, the decision to use LP should not be guided by urinalysis results alone.

Bacterial Meningitis Among Adult Patients at University of Gondar Comprehensive Specialized Referral Hospital.

BackgroundBacterial meningitis is a bacterial infection that causes inflammation of the membranes that surround the brain and spinal cord. The most frequent causes of bacterial meningitis are Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes, and Haemophilus influenzae. This study aimed to determine bacterial meningitis and their antibiotic susceptibility patterns among adult patients.MethodsA retrospective cross-sectional study was conducted on records of 3,683 patients to determine bacterial meningitis and their antibiotic susceptibility patterns from 2011 to 2020. Cerebrospinal fluid samples were collected, inoculated on blood and chocolate agar plates, and then incubated at 37°c for 24 hours. Bacterial identification performed using morphological characters, Gram stain, and biochemical tests. And then antimicrobial susceptibility tests were done using modified Kirby–Bauer disk diffusion technique. Records of 3,683 culture results were collected and reviewed using a checklist from the registration book. Finally, data was entered, cleared, and checked using Epi-info version 7 and exported to SPSS version 20 for analysis.ResultsOf the 3,683 patients, the overall prevalence of culture-positive bacterial meningitis was 1.28% (47/3683). Of them, bacterial meningitis in males was 1.61% (33/2052). Streptococcus pneumoniae (32%, 15/47) was the commonest isolate followed by Staphylococcus aureus, (12.80%, 6/47), Escherichia coli, (12.80%, 6/47), and Neisseria meningitidis, (10.60%, 5/47). Out of 47 culture-positive isolates, 15 of them were MDR isolates. Ceftriaxone, chloramphenicol, ciprofloxacin, vancomycin, clindamycin, and erythromycin were the most effective antibiotics whereas penicillin, tetracycline, and cotrimoxazole were the least effective antibiotics for isolates. Gender (P = 0.047, AOR = 0.528, CI = 0.282–0.99) is significantly associated with bacterial meningitis.ConclusionThe prevalence of bacterial meningitis among adult patients was 1.28%. Males are at high risk for bacterial meningitis compared to females. Therefore, infection preventive measures are required with a particular focus on adult patients. Further research is needed to explore the epidemiology and risk factors of bacterial meningitis.

78 CONCOMITANT MENINGITIS AMONG FEBRILE YOUNG INFANTS 29-60 DAYS OLD WITH A POSITIVE URINALYSIS AND THE NEED FOR LUMBAR PUNCTURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Fever among infants in the first months of life remains among the most common pediatric problems in the Emergency Department (ED) setting. These infants are at increased risk of potentially life-threatening serious bacterial infection (SBI), specifically urinary tract infections (UTIs), bacteremia and bacterial meningitis. Infants with UTIs have historically been considered at increased risk of bacterial meningitis. A presumptive diagnosis of UTI relies entirely upon abnormal urinalysis results in the ED, prompting further invasive testing by lumbar puncture, broad-spectrum antibiotic exposure and hospitalization. However, the necessity of lumbar puncture for infants older than 28 days on the basis of an abnormal urinalysis has been questioned for over a decade and remains controversial. Objectives The objective of this study was to estimate the prevalence of meningitis among well-appearing, febrile infants aged 29-60 days with a positive urinalysis, to inform whether routine CSF testing is required in these patients. Design/Methods We searched MEDLINE and Embase for articles published from January 1, 2000 to July 25, 2018, deliberately limiting the search to recent studies to account for: 1) changing SBI epidemiology; 2) evolving clinical definitions of UTI; and, 3) improvements in urinalysis diagnostic accuracy for febrile young infants. Studies were eligible for inclusion if they reported urinalysis results and SBI prevalence. In the case of studies reporting UTI prevalence but not UA results, or aggregate data only, the corresponding authors were contacted for details. The primary outcome was the prevalence of culture-proven bacterial meningitis among infants with a positive urinalysis. The secondary outcome was the prevalence of bacterial meningitis among infants with a positive urinalysis, defined by either a positive CSF culture or a suggestive history at 1-month post-discharge if CSF testing was not undertaken in the ED. Studies were assessed for bias using the Critical Appraisal Skills Programme (CASP) tool, and prevalence estimates for bacterial meningitis were pooled in a random effects meta-analysis. Results The parent search yielded 2334 unique citations, of which screening by title and abstract identified 106 for full text review. Eleven studies met inclusion and were ultimately included in the final meta-analysis. Seven studies did not have significant risk of bias for the primary outcome of interest. Among 1430 febrile infants with a positive urinalysis and CSF testing performed, 5 infants had culture-proven bacterial meningitis (primary outcome; prevalence 0.33%, 95% CI: 0.1% to 0.79%). Only these same 5 infants were considered to have bacterial meningitis among 2311 infants with a positive urinalysis and meningitis status ascertained by either CSF testing or clinical follow-up (secondary outcome; prevalence 0.24%, 95% CI: 0.08 to 0.54%). Conclusion The prevalence of bacterial meningitis in well appearing febrile infants aged 29-60 days with a positive urinalysis is low. The practice of lumbar puncture in this subgroup of infants should not be guided by urinalysis results alone, but rather on the basis of other clinical criteria. Results should inform decisions regarding invasive testing and aid in shared decision-making.

Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life

Febrile neonates (persons in the first month of life) are believed to be at higher risk for bacteremia or bacterial meningitis than infants in their second month of life. However, the true prevalence is unclear. To determine modern rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life presenting to an ambulatory setting. A comprehensive, no-limit search was conducted in PubMed using previously published search terms in February 2015 and repeated in September 2016. Abstracts and full texts were reviewed independently by several investigators. Studies were included if data regarding blood cultures or cerebrospinal fluid cultures from consecutive febrile infants in an ambulatory setting could be extrapolated within the age groups. To limit the analysis to the period after the availability of the Haemophilus influenzae type b vaccination, studies that collected data before 1990 were excluded. Data were extracted in accordance with the Meta-analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines via independent abstraction by several investigators. The Newcastle-Ottawa Scale was used to assess bias. The primary outcomes were prevalence rates of bacteremia and bacterial meningitis in febrile neonates and infants in the second month of life. In neonates, prevalence rates were also estimated in the era of group B Streptococcus intrapartum antibiotic prophylaxis (after 1996). In total, 7264 abstracts were screened, resulting in 188 full-text manuscripts reviewed, with 12 meeting inclusion criteria (with 15 713 culture results). For febrile neonates, the prevalence of bacteremia was 2.9% (95% CI, 2.3%-3.7%; I2 = 50%; n = 5145) and the prevalence of bacterial meningitis was 1.2% (95% CI, 0.8%-1.9%; I2 = 27%; n = 3288). In neonates in the era after group B Streptococcus prophylaxis, the prevalence of bacteremia was 3.0% (95% CI, 2.3%-3.9%; I2 = 6%; n = 2055) and the prevalence of meningitis was 1.0% (95% CI, 0.4%-2.1%; I2 = 28%; n = 1739). For febrile infants in the second month of life, the prevalence of bacteremia was 1.6% (95% CI, 0.9%-2.7%; I2 = 78%; n = 4778) and the prevalence of meningitis was 0.4% (95% CI, 0.2%-1.0%; I2 = 33%; n = 2502). These findings suggest that febrile neonates have approximately twice the rate of bacteremia and meningitis as febrile infants in their second month of life.

The Prevalence of Bacterial Meningitis in Febrile Infants 29-60 Days With Positive Urinalysis.

This study evaluates whether bacterial meningitis prevalence differs by urinalysis result and whether antibiotic treatment of presumed urinary tract infection without cerebrospinal fluid (CSF) culture produces adverse sequelae in febrile infants 29 to 60 days old. This retrospective cohort study identified febrile infants 29 to 60 days old presenting to Kaiser Permanente Northern California sites from 2007 to 2015 who underwent urinalysis and blood, urine, and CSF cultures, comparing the prevalence of meningitis among infants with positive versus negative urinalysis results using a two 1-sided test for equivalence. Additionally, febrile infants treated with antibiotics for positive urinalysis results without CSF culture were identified and their charts were reviewed for adverse sequelae. Full evaluation was performed in 833 febrile infants (835 episodes). Three of 337 infants with positive urinalysis (0.9%; 95% confidence interval [CI]: 0.0%-1.9%) and 5 of 498 infants with negative urinalysis (1%; 95% CI: 0.1%-1.9%) had meningitis. These proportions were statistically equivalent within 1%, using two 1-sided test with a P value of .04. There were 341 febrile infants (345 episodes) with positive urinalysis treated with antibiotics without lumbar puncture. Zero cases of missed bacterial meningitis were identified (95% CI: 0%-1.1%). Zero cases of severe sequelae (sepsis, seizure, neurologic deficit, intubation, PICU admission, death) were identified (95% CI: 0%-1.1%). The prevalence of bacterial meningitis does not differ by urinalysis in febrile infants 29 to 60 days old. Antibiotic treatment of infants with positive results for urinalysis without lumbar puncture may be safe in selected cases.

Etiological patterns of bacterial meningitis in neonatal sepsis

Background Sepsis and meningitis are major causes of mortalityand morbidity in neonates. The prevalence of sepsis is around 1-4out of every 1000 live births, and one-fourth is accompanied bymeningitis. These numbers are higher in prematures.Objective To find out the prevalence and etiological patterns ofbacterial meningitis in neonatal sepsis, and the pattern of antibi-otic susceptibility for organisms causing bacterial meningitis.Methods This was a cross sectional study, conducted in the neo-natal ward and emergency room at Cipto Mangunkusumo Hospi-tal from October 2003 to October 2004.Results Seventy two neonates fulfilled the inclusion criteria andwere examined for blood and cerebrospinal fluid (CSF) cultures.Sixty out of 72 neonates were proven for sepsis. Bacterial menin-gitis was found in 18 neonates, and all cases were accompaniedby sepsis. Positive CSF cultures were found in 12 neonates. Theother six were diagnosed based on CSF cell count &gt;32/μl.Acinetobacter calcoaceticus was the major causative organismsin this study. The organisms were highly resistant to first line anti-biotics, except for chloramphenicol. They were also sensitive toceftazidime (second line), meropenem, and imipenem.Conclusions The prevalence of bacterial meningitis in neonatalsepsis at Cipto Mangunkusumo Hospital was 18/60 in 2003-2004.The major causative organism was Acinetobacter calcoaceticus.Antibiotic resistance was very high and only chloramphenicol,ceftazidime, meropenem, and imipenem remain effective

Prevalence and Antibiotic Resistance of Neonatal Sepsis Pathogens in Neyshabour, Iran

Background: Neonatal sepsis is a systemic inflammatory response syndrome that is secondary to infection. It is a major cause of neonatal mortality in the world, particularly in developing countries. A definitive diagnosis requires the isolation of pathogens from a normally sterile body site, including blood, cerebrospinal fluid and urine. Empirical antibiotic therapy is based on the physician’s knowledge of the anticipated bacterial species and their expected antibiotic susceptibilities. Objectives: The aim of this study was to determine the prevalence and evaluate the antimicrobial susceptibility patterns of bacterial infections at a neonatal unit. Patients and Methods: This study was conducted at the neonatal intensive care unit and neonatal ward of Hakim hospital, Neyshabour, Iran. Blood, cerebrospinal fluid (CSF) and urine specimens were collected before institution of empirical antibiotic therapy. Antibiotic resistance pattern of the isolates was studied by the disc diffusion technique. Results: Coagulase-negative staphylococci (CoNS) were the most prevalent pathogens isolated from blood specimens in early and late-onset disease. Escherichia coli and Klebsiella were the most causative pathogens in early and late-onset urinary tract infections. They had high resistance to our empirical antibiotic regimens. Prevalence of bacterial meningitis was low in our study. Conclusions: Due to the increasing resistance of pathogens to usual empirical antibiotics, it is reasonable to stress upon preventive measures, so that a minimum number of neonates develop sepsis.

Predictors of Meningitis with First Febrile Seizure

Researchers in Delhi, India, investigated the prevalence of bacterial meningitis in 497 children aged 6-18 months admitted to hospital with a first seizure with fever.

Enrichment culture of CSF is of limited value in the diagnosis of neonatal meningitis

Neonatal meningitis is difficult to diagnose due to the subtle and nonspecific symptoms in neonates, and confirmation requires cerebrospinal fluid examination (CSF) [1]. Gram stain, culture of CSF directly onto agar plates, and broth enrichment culture are well established methods for diagnosing bacterial meningitis [2–5]. Other methods under evaluation include use of bacterial polymerase chain reaction combined with DNA sequencing [6]. The aim of CSF broth enrichment culture is to facilitate the isolation of damaged organisms and to recover those present in small numbers [7, 8]. The exact origin of enrichment culture is unknown [9]. Beijerinck and Winogradski are believed to be the first to recommend enrichment techniques [10]. We previously reported on the utility of various microbiology tests for the diagnosis of bacterial meningitis in the newborn [7]. We showed that enrichment cultures (inoculation of CSF into a brain-heart infusion broth incubated for 48 hrs) when performed on all lumbar puncture specimens are often falsely positive, because the prevalence of true bacterial meningitis is low in neonatal intensive care units and the test lacks specificity. We suggested that enrichment culture should be confined to settings where the prevalence of bacterial meningitis was higher, such as in samples with raised CSF white cell count (WCC), where organisms are seen on the Gram stain or where pathogens may be difficult to grow such as when babies have already received antibiotics. The aim of our current study was to assess the performance of enrichment culture when performed on CSF samples selected on the basis of a raised WCC of ≥30 /mm3.

Meningitis in elderly patients

Meningitis is uncommon in elderly patients in emergency department (ED). The characteristics of bacterial meningitis (BM) and nonbacterial meningitis (NBM) occurring in older patients are compared. A prospective multicenter study was conducted in the EDs of three teaching hospitals. Consecutive adult patients (n=159) with a confirmed meningitis [cerebrospinal fluid (CSF) leukocyte count greater than 5 mm] were included in this study. Eighteen consecutive patients (11%) aged more than or equal to 60 years (median age of 67 years) presenting with confirmed meningitis were included. In the older group, the prevalence of BM was higher than in the younger group (50% vs. 11%, P<0.05). At admission in the ED, older patients experienced less typical symptoms of meningitis than the younger. Conversely, elderly patients presented more frequent signs of encephalitis. In older adults, CSF white blood cells count, CSF protein, and CSF/blood glucose ratio were different between NBM and BM. The causative species of BM were Streptococcus species other than pneumoniae in two episodes, and Streptococcus pneumoniae in two patients; the causative species of NBM were enterovirus in one episode, herpes simplex virus 1 in four (compared with the younger group, P<0.05), and varicella zoster virus in one. The prevalence of BM was higher in the older group than in the younger. Older patients experienced less typical symptoms of meningitis and more frequently signs of encephalitis, with a high prevalence of herpes simplex virus 1 meningitis.

C-reactive protein and bacterial meningitis: a meta-analysis

The aim of the study was to review published articles on the diagnostic accuracy of C-reactive protein (CRP) tests with cerebrospinal fluid and serum in diagnosing bacterial meningitis. The literature from 1980 and onwards was searched using the electronic databases of MEDLINE, and we used summary receiver operating characteristic curve analyses (SROCs) to describe central tendencies and examine possible sources of inter-study variability in the results. We included data from 35 studies of both children and adults: 21 in which CRP had been measured in cerebrospinal fluid, 10 in which CRP had been measured in serum, and 4 in which it had been measured in both cerebrospinal fluid and serum. The odds ratio for bacterial meningitis versus aseptic meningitis for a positive CRP test with cerebrospinal fluid was estimated at 241 (95% confidence interval [CI]: 59-980), and the central tendencies for the true-positive fraction (sensitivity) and the false-positive fraction (1-specificity) were estimated at 0.94 and 0.06, respectively. The corresponding figures for a CRP test with serum were 150 (95% CI: 44-509), 0.92 and 0.08, respectively. Regression analyses including variables coding for study design features, inclusion of neonatal patients, geographical region, or use of a quantitative biochemical method did not indicate statistically significant contributions to inter-study variances in the log odds ratios. For values of the true- and the false-positive fractions of 0.92-0.94 and 0.06-0.08, respectively, the post-test probability of not having bacterial meningitis given a negative test is very high (> or = 97%), in the range of a pre-test probability (prevalence of bacterial meningitis) from 10 to 30%, whereas the post-test probability of bacterial meningitis given a positive test is considerably lower. Hence, only a negative test is highly informative in a typical clinical setting. This, as well as the absence of analyses to show if CRP tests contribute independent diagnostic information, relatively to the information held in the traditionally used clinical and biochemical variables, makes it difficult to conclude on the clinical usefulness of CRP tests in the management of patients suspected of having bacterial meningitis.

Acute phase reactants and risk of bacterial meningitis among febrile infants and children

To test the hypothesis that quantitation of either C-reactive protein (CRP) or the total peripheral WBC count can improve clinical detection of underlying bacterial meningitis among young febrile children. Cross-sectional survey of selected symptoms of central nervous system infection, signs of meningeal irritation and/or elevated intracranial pressure, levels of CRP in serum, and total peripheral WBC counts among unselected pediatric patients undergoing lumbar punctures for evaluation of acute febrile illnesses. Emergency department and acute care "walk-in" clinic of an urban, university-affiliated general hospital. 160 previously well, acutely febrile infants and children (median age, 6 months). The prevalence of bacterial meningitis was 6%. Sensitivity of symptoms was 1.00 and specificity was 0.17. Sensitivity of signs was 0.70 and specificity was 0.81. Of the acute phase reactants, sensitivity of a CRP level of more than 1.0 mg/dL was 0.80, while that of a total peripheral WBC count of more than 15,000/mm3 was 0.40. The presence of signs and/or a CRP level of more than 1.0 mg/dL correctly identified all children with bacterial meningitis (sensitivity, 1.00). The absence of signs and a CRP level of 1.0 mg/dL or less correctly identified 71 of 150 children without bacterial meningitis (specificity, 0.47). Of 125 children without meningeal signs, the combination of symptoms and a CRP level of more than 1.0 mg/dL correctly identified all three children with bacterial meningitis (sensitivity, 1.00). The absence of these symptoms and/or a CRP level of 1.0 mg/dL or less correctly identified 80 of 122 children without bacterial meningitis (specificity, 0.66). Quantitation of CRP but not the total peripheral WBC count can increase the sensitivity of physical examination findings and the specificity of symptoms for the diagnosis of bacterial meningitis. Measurement of CRP in serum is useful as an adjunct to history and physical examination for the detection of acute bacterial meningitis in the acutely febrile child.