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[CSF. changes in partially treated bacterial meningitis (author's transl)]
Abstract:
Review of 102 admissions of children (one month to seven years of age) with bacterial meningitis is presented. 46 of the patients (45%) had been treated previously with one or more antibiotics. Previous treatment made culture of CSF negative in a statistically significant (p less than 0.001) number of cases, mainly in meningococcal meningitis. There were no significant differences in the levels of CSF glucose, proteins and WBC's between both groups. A decrease of the percentage PMN/lymphocytes was found in the CSF of the partially treated group. In 7 out of 102 no more than two CSF pathological findings were present. In 5 or 7 CSF cultures were positive. In the other two there were pathological changes in CSF even with correct dosage of previous antibiotics. In 4 patients with positive cultures and little changes in CSF on admission, LP after 48 hours of correct treatment showed an increase in the alterations of CSF. This could mean that previous low dosage antibiotic treatment should not modify CSF findings enough not to make correct diagnosis.
Insights
Previous antibiotic treatment in children with bacterial meningitis can lead to negative cerebrospinal fluid (CSF) cultures, complicating diagnosis. However, key CSF findings may still indicate infection, aiding diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Context:
- Bacterial meningitis is a serious infection in children.
- Accurate diagnosis relies on cerebrospinal fluid (CSF) analysis.
- Antibiotic stewardship is crucial in pediatric infectious diseases.
Purpose:
- To evaluate the impact of prior antibiotic treatment on the diagnostic accuracy of CSF analysis in pediatric bacterial meningitis.
- To assess changes in CSF parameters (cultures, glucose, protein, WBC, PMN/lymphocyte ratio) following partial antibiotic treatment.
Summary:
- A review of 102 pediatric bacterial meningitis admissions found 45% received prior antibiotics.
- Prior antibiotic treatment significantly reduced CSF culture positivity (p < 0.001), especially in meningococcal meningitis.
- Despite negative cultures, CSF analysis including PMN/lymphocyte ratios and changes after treatment initiation can still aid diagnosis.
Impact:
- Highlights the challenge of diagnosing bacterial meningitis in partially treated children.
- Suggests that CSF findings, even with prior antibiotic exposure, remain valuable for diagnosis.
- Emphasizes the need for careful interpretation of CSF results in the context of antibiotic history.