Bacterial meningitis presenting with a normal cerebrospinal fluid leukocyte count - 05/05/22
Highlights |
• | Patients with bacterial meningitis may present with normal CSF leukocyte counts. |
• | In these patients, the CSF protein and Gram stain are important diagnostic tests. |
• | Severe pneumococcal meningitis with a fulminant disease course was common (51%). |
• | Outcome is often unfavorable (59%) and the mortality rate is high (30%). |
Abstract |
Objectives |
We describe clinical characteristics and outcome of adults with bacterial meningitis presenting with a normal CSF leukocyte count.
Methods |
We studied community-acquired bacterial meningitis with a normal CSF leukocyte count (≤ 5 per mm3) in adults from a prospective nationwide cohort study.
Results |
From 2006 through 2020, 39 of 2,357 (2%) episodes presented with a normal CSF leukocyte count. Immunocompromising conditions were present in 19 of 39 patients (49%), compared to 690 of 2303 (30%) in patients with elevated leukocytes (P = 0.02). The triad of fever, neck stiffness, and altered consciousness was present in 6 of 34 patients (18%). CSF protein was abnormal in 25 of 37 patients (68%). We identified 3 clinical subgroups: those with severe pneumococcal meningitis (20 patients [51%]), with mainly sepsis (8 [21%]), and a miscellaneous group (11 [28%]). All patients with severe pneumococcal meningitis presented with high CSF protein levels and 18 of 19 (95%) had bacteria in the CSF Gram stain. Outcome was unfavorable in 23 of 39 (59%) patients and 12 (31%) died.
Conclusion |
Patients with bacterial meningitis may present with normal CSF leukocyte counts. In these patients, CSF protein levels and Gram staining are important diagnostic parameters.
Le texte complet de cet article est disponible en PDF.Keywords : Bacterial meningitis, Leukocytosis, Prospective cohort study, Signs and symptoms, Outcome
Plan
Vol 84 - N° 5
P. 615-620 - mai 2022 Retour au numéro
Article précédent
- Editorial Board
- Socioeconomic functioning in patients with brain abscess – a nationwide, population-based cohort study in Denmark
- Lars Haukali Omland, Jacob Bodilsen, Jannik Helweg-Larsen, Jens Otto Jarløv, Morten Ziebell, Svend Ellermann-Eriksen, Ulrik Stenz Justesen, Niels Frimodt-Møller, Niels Obel
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