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Diagnosing and prognosticating acute meningitis in young infants within 24 hours of admission

K C See1, S K Tay, P S Low

  • 1Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.

Annals of the Academy of Medicine, Singapore
|October 18, 2001
PubMed

Insights

Early diagnosis of acute meningitis in infants is challenging. The cerebrospinal fluid-to-blood glucose ratio within 24 hours effectively predicts acute bacterial meningitis and neurological outcomes.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Neurology

Background:

  • Acute meningitis in infants under 90 days old lacks extensive study regarding early diagnosis and prognosis.
  • Investigating diagnostic and prognostic factors within 24 hours of admission is crucial for this vulnerable population.

Purpose of the Study:

  • To identify key diagnostic factors for acute meningitis in young infants within 24 hours of hospital admission.
  • To determine prognostic factors for unfavorable neurological outcomes in infants with acute meningitis.

Main Methods:

  • A retrospective case review was conducted on 55 young infants diagnosed with acute meningitis between 1991 and 1999.
  • Analysis focused on clinical symptoms, physical signs, and laboratory values, particularly the cerebrospinal fluid (CSF)-to-blood glucose ratio.

Main Results:

  • Common symptoms included fever, abnormal activity, and decreased feeding; common signs were elevated temperature, irritability, and abnormal tone/reflexes.
  • The CSF-to-blood glucose ratio proved to be the strongest predictor for both acute bacterial meningitis (ABM) and unfavorable neurological outcome (UFNO).
  • A CSF-to-blood glucose ratio ≤0.8 demonstrated 100% sensitivity and NPV for ABM diagnosis, while ≤0.3 showed 100% specificity and PPV. The same ratio (≤0.3) predicted UFNO with 100% sensitivity and NPV.

Conclusions:

  • Diagnosing acute meningitis solely on clinical presentation is difficult in young infants.
  • Laboratory tests, specifically the CSF-to-blood glucose ratio, significantly aid in the rapid diagnosis of ABM and prognosis of UFNO within 24 hours.
Abstract

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