![]() ![]() The objective of the present study was to establish a cutoff point of CSF WBC count that distinguished bacterial from viral and aseptic meningitis. Therefore, our aim was to verify the possibility of using the CSF WBC count in an initial evaluation of BM. However, in some institutions, these results can be time consuming, and in some cases are impossible to be obtained. 11–13 More recently, some isolated factors 14,15 also proved to be good parameters to differentiate bacterial from VM. Some scores like the BM score and the Meningitest have a high sensitivity and are proven to be valid when evaluating a child with meningitis. 10 Some criteria such as Gram staining, bacterial antigen testing of cerebrospinal fluid (CSF) as well as the classic biological markers in the blood (CRP level, white blood cell count, and neutrophil count) or CSF (protein level, glucose level, WBC count, and neutrophil count) can be used to help predicting BM. Because the consequences of delayed diagnosis of BM can be severe, any proposed diagnostic tool must achieve near 100% sensitivity. ![]() Therefore, distinguishing BM from other types of meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. However, antibiotic therapy results in systematic hospitalization and unnecessary antibiotic administration for children with aseptic or viral meningitis (VM), with the associated morbidity and economic costs. When approaching a child with meningitis it is known that an early introduction of antibiotic treatment assures rapid treatment of children with BM. 6,7 More recently, meningococcal conjugate type C and pneumococcal vaccines have also contributed to change the epidemiological profile of this disease. The incidence of invasive disease by Haemophilus influenzae (Hib) decreased dramatically in populations with high immunization coverage rates. 4,5 The implementation of vaccination programs allowed a remarkable reduction in incidence and mortality of infectious diseases. 3 The most common etiological agents are Neisseria meningitidis and Streptococcus pneumoniae, the latter being associated with a higher rate of severe and permanent sequelae, and mortality. 1,2 Bacterial meningitis (BM) can cause serious complications and its severity depends not only on the causal microorganism, but also on host immune factors, immunization status, and geographic region. ![]() Therefore, the value of cerebrospinal fluid white blood cell count was found to be a useful and rapid diagnostic test to distinguish between bacterial and nonbacterial meningitis in children.ĭespite the advances in diagnosis and treatment of infectious diseases, meningitis is still considered as an important cause of mortality and morbidity, specially in the pediatric population. ![]() A cutoff value of 321 white blood cell/μL showed the best combination of sensitivity (80.6%) and specificity (81.4%) for the diagnosis of bacterial meningitis (area under receiver operating characteristic curve 0.837). cerebrospinal fluid white blood cell count was significantly higher in patients with bacterial meningitis (mean, 4839 cells/μL) compared to patients with aseptic meningitis (mean, 159 cells/μL, p < 0.001), with those with aseptic meningitis (mean, 577 cells/μL, p < 0.001) and with all non-bacterial meningitis cases together ( p < 0.001). Bacterial meningitis was caused by Neisseria meningitidis (48.4%), Streptococcus pneumoniae (32.3%), other Streptococcus species (9.7%), and other agents (9.7%). Thirty one children (10.5%) were diagnosed with bacterial meningitis, 156 (52.9%) viral meningitis and 108 (36.6%) aseptic meningitis. There were 295 patients with cerebrospinal fluid pleocytosis, 60.3% females, medium age 5.0 ± 4.3 years distributed as: 12.2% 1–3 months 10.5% 3–12 months 29.8% 12 months to 5 years 47.5% >5 years. The cases of traumatic lumbar puncture and of antibiotic treatment before lumbar puncture were excluded. A retrospective study of children aged 29 days to 17 years who were admitted between January 1st and December 31th, 2009, with cerebrospinal fluid pleocytosis (white blood cell ≥ 7 μL −1) was conducted. Our aim was to establish a cutoff point of cerebrospinal fluid white blood cell count that could distinguish bacterial from viral and aseptic meningitis. Although some clinical prediction rules, such as bacterial meningitis score, are of well-known value, the cerebrospinal fluid white blood cells count can be the initial available information. Children with cerebrospinal fluid pleocytosis are frequently treated with parenteral antibiotics, but only a few have bacterial meningitis. ![]()
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