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Clinical predictors of bacterial versus aseptic meningitis in childhood
C Walsh-Kelly1, D B Nelson, D S Smith
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.
Insights
Meningeal signs are unreliable for diagnosing meningitis in infants under 12 months. A high suspicion for meningitis is crucial in febrile infants, regardless of physical findings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Meningitis diagnosis in children relies on clinical signs, but their reliability varies with age.
- Meningeal signs are key indicators, yet their predictive value in young children is debated.
Purpose of the Study:
- To evaluate the accuracy of meningeal signs and other physical findings in identifying bacterial and aseptic meningitis across different pediatric age groups.
Main Methods:
- Prospective evaluation of children under 17 years old requiring lumbar puncture.
- Assessment of meningeal signs and physical parameters before lumbar puncture in 172 children with confirmed meningitis.
Main Results:
- Nuchal rigidity was significantly less common in infants (0-6 months) with bacterial (27%) or aseptic (3%) meningitis compared to older children (95% and 79%, respectively).
- Seventy-two percent of infants (≤12 months) with bacterial meningitis had positive meningeal signs, versus 17% with aseptic meningitis.
- In children over 12 months, 85% showed at least one positive meningeal sign, regardless of meningitis type.
Conclusions:
- Meningeal signs have limited reliability in diagnosing meningitis in infants 12 months and younger.
- A high index of suspicion for meningitis is essential in febrile infants under 12 months, even without clear meningeal signs.
Study Objective:
To assess the reliability of meningeal signs and other physical findings in predicting bacterial and aseptic meningitis at various ages.
Design:
Children requiring lumbar puncture were evaluated prospectively for meningeal signs and other physical parameters before lumbar puncture.
Setting:
Emergency department of Children's Hospital of Wisconsin.
Participants:
One hundred seventy-two children, aged 1 week to 17 years, with meningitis (53 bacterial and 119 aseptic).
Measurements And Main Results:
Nuchal rigidity was present in 27% of infants aged 0 to 6 months with bacterial meningitis versus 95% of patients 19 months or older (P = .0001). Three percent of infants 0 to 6 months old with aseptic meningitis had nuchal rigidity versus 79% of patients 19 months or older (P = .0005). Seventy-two percent of infants 12 months of age or younger with bacterial meningitis has at least one positive meningeal sign versus 17% of infants with aseptic meningitis (P = .0001). Eighty-five percent of children older than 12 months with meningitis had at least one positive meningeal sign, 93% with bacterial meningitis, and 82% with aseptic meningitis.
Conclusion:
Despite a lack of meningeal signs, a high index of suspicion for meningitis is essential when evaluating the febrile infant 12 months of age or younger.