If meningitis is suspected, empiric antibiotics/antifungals should be administered regardless of initial WBC count on lumbar puncture. We recommend ordering blood cultures as an adjunct, and, if clinically relevant, concomitant sources of infection should be sought. If this occurs, causative organism is likely bacterial.
Meningitis in the absence of pleocytosis on CSF is rare. In addition to bacteremia, concomitant sources of infection occurred in 17 cases. Blood cultures were performed in 79 of the 124 cases, 56 (71%) of which ultimately cultured the causative organism. The overall percentage of positive initial CSF PCR/culture for viral, fungal and bacterial organisms was 100, 89 and 82%, respectively. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. Outcome was reported in 86 cases, 27 of which died and 59 survived. Causative organisms were primarily bacterial (99 cases). ResultsĪ total of 124 cases from 51 articles were included. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Further, there is little available literature on the subject. However, meningitis may occur in the absence of pleocytosis on CSF.Īreas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. Clin Infect Dis 2008 47:303-327.Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Practice Guidelines for the Management of Bacterial Meningitis. Impact of in-hospital enteroviral polymerase chain reaction testing on the clinical management of children with meningitis. Comparison of antibiotic and acyclovir usage before and after the implementation of an on-site FilmArray meningitis/encephalitis panel in an academic tertiary pediatric hospital: a retrospective observational study. Hagen, A., Eichinger, A., Meryer-Buehn, M., Schober, T., & Huebner, J.Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections. European Journal of Clinical Microbiology & Infectious Diseases 2019 39(2):293-297. Impact of a multiplex PCR assay (FilmArray®) on the management of patients with suspected central nervous system infections. European Journal of Clinical Microbiology & Infectious Diseases Jul 2020. Impact of cerebrospinal fluid syndromic testing in the management of children with suspected central nervous system infection. Diagnostic Microbiology and Infectious Disease 2020 96(2):114935. Impact of the implementation of a rapid meningitis/encephalitis multiplex polymerase chain reaction panel on IV acyclovir duration: multicenter, retrospective cohort of adult and pediatric patients. The Pediatric Infectious Disease Journal 2018 37:868-71. Impact of cerebrospinal fluid multiplex assay on diagnosis and outcomes of central nervous system infections in children: a before and after cohort study.
Diagnosis, Initial Management, and Prevention of Meningitis.
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