(5) also looked at the diagnostic value of CSF protein levels. (5) also looked at the diagnostic value of CSF protein levels. The patient continued to be febrile despite 72 hours of antibiotic therapy. Among children with CSF pleocytosis, a prediction model based exclusively on age, CSF total protein and CSF neutrophils differentiates accurately between acute bacterial and viral meningitis. and Kurtz, J.B. / de Crom, Stephanie C. In clearing the test, the FDA cited a multicenter study in which 96% of patients who tested positive did have viral meningitis, and 97% of patients who tested negative did not have viral meningitis.
Mean length of stay for patients with aseptic meningitis was 2.3 days (SD, +/-1.4 days). CONCLUSIONS: Among infants with EV CNS infections, the absence of CSF pleocytosis is related to younger age and lower peripheral WBC counts, perhaps reflecting the decreased ability of younger infants to mount a robust inflammatory response to EV infection. Enterovirus was isolated 43 % of the CSF specimens. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. We recognized an opportunity to examine the relationship between UTI, CSF pleocytosis and EV infection in a large population of febrile infants. Seventy-six (95%), 67 (83.7%), 51 (63.7), and 2 (2.5%) patients presented with fever, headache, vomiting, and seizure, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively.
Louis, MO 63110. Mean length of stay for patients with aseptic meningitis was 2.3 days (SD, ±1.4 days). Statistical significance was determined as a 2-tailed p value of 0.05, data not shown). Human enteroviruses (HEV) are small, single-stranded RNA viruses, belonging to the large genus Enterovirus of the Picornaviridae family and classified into four distinct species according to their molecular properties: HEV-A, B, C, and D . One hundred fifty-eight cases of meningitis were reviewed: 138 were aseptic and 20 were bacterial. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The data indicate that HPeV infection is predominant in young infants (22/mm3 in subjects aged under 4 weeks, >15/mm3 for subjects aged 4-7 weeks, >5/mm3 for subjects aged over 7 weeks.
© 2008 Wiley-Liss, Inc. Subsequently, it was recognized that aseptic meningitis was a syndrome that could have multiple causes, both infectious and noninfectious (Wallgren 1951). The Charlson comorbidity scale and data on IV drug use were not routinely recorded. Seven had fever and 5 had a stiff neck. 16.Robert L, Margaret AM, Thomas JM, Haldane EV. Whether CSF pleocytosis plays an important role in defining aseptic meningitis or in prioritizing the differential diagnosis has been investigated but is still not completely clear (7, 14, 17). Conclusions.
The finding of a predominantly polymorphonuclear (PMN) leukocyte pleocytosis in the CSF further suggested the possibility of a bacterial infection. Viral loads were associated with EV genotypes (P < .001). Subacute and chronic meningitis may result from a wide variety of organisms and conditions. Neonates with EV infection should be investigated for evidence of periventricular leukomalacia, screened for myocarditis, and considered for IVIG treatment. Of the 86 CSF samples collected in the acute phase, 11 had no pleocytosis (or=10 white blood cells/mm(3)). The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated. In 4 lymphoma cases (11.8%) a false-negative diagnosis and in 7 cases (10.6%) of viral meningitis a false-positive diagnosis were made. Although enterovirus infections themselves are generally benign, clinical features of enteroviral meningitis can overlap those of bacterial infections and herpes simplex virus infection, resulting in prolonged hospital stays and presumptive treatment until a diagnosis is established. 2000; 49:185. Our three decades data revealed that patient numbers of Group B Streptococcus, Streptoccus pneumoniae, and Haemophilus influenzae type b meningitis declined but Escheria coli meningitis increased in the late period . In accordance with the work of Nigrovic et al. Only the peripheral white blood cell count was independently associated with sterile CSF pleocytosis, and patients with a peripheral white blood cell count of 15/μL or higher had twice the odds of having sterile CSF pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). ISSN 1413-8670. These findings may indicate that the inflammatory response is more likely responsible for dissections . Treatment with daily high-dose IVIg was commenced, with significant clinical improvement. The median (range) beta-glucuronidase activity in UTI with sterile CSF pleocytosis was 44.1 (33.2-57.1), whereas in the controls without CSF pleocytosis it was 19.1 (7.0-22.7), in aseptic meningitis of apparently viral etiology it was 26.5 (21.0-30.0) and in bacterial meningitis it was 168 (70.0-1152). These criteria have been established to predict low-risk patients less than 3 months of age with serious bacterial infections and include the Rochester, Philadelphia, and Boston criteria.3-5 The purpose was to screen young infants at risk for serious bacterial infections that included bacteremia, urinary tract infection, or bacterial meningitis.