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Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective

Martijn Weisfelt1, Diederik van de Beek, Lodewijk Spanjaard

  • 1Department of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.weisfelt@amc.uva.nl

BMC Infectious Diseases
|October 14, 2006
PubMed
Abstract

Insights

A low cerebrospinal fluid (CSF) white-blood cell count (WBC) in pneumococcal meningitis is linked to sepsis and poor outcomes. This suggests invasive pneumococcal infections may represent a spectrum from meningitis to sepsis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • A low cerebrospinal fluid (CSF) white-blood cell count (WBC) is a known risk factor for adverse outcomes in bacterial meningitis.
  • While a low CSF WBC indicates sepsis in meningococcal meningitis, its association with outcomes in pneumococcal meningitis remains unclear.

Purpose of the Study:

  • To investigate the relationship between CSF WBC, bacteremia, and sepsis in adult patients with pneumococcal meningitis.
  • To determine if a low CSF WBC is associated with unfavorable outcomes and systemic complications in pneumococcal meningitis.

Main Methods:

  • Prospective cohort study of 352 episodes of pneumococcal meningitis in patients over 16 years old.
  • Analysis of CSF WBC counts, blood cultures, and clinical outcomes (Glasgow Outcome Scale).
  • Multivariate analysis to identify factors associated with low CSF WBC.

Main Results:

  • 33% of patients had a CSF WBC <1000/mm3, and these patients were more likely to have unfavorable outcomes (71% vs. 43%).
  • Low CSF WBC was associated with positive blood cultures (86% vs. 70%) and systemic complications (51% vs. 32%).
  • Factors associated with low CSF WBC included advanced age, positive blood culture, and low thrombocyte count.

Conclusions:

  • Low CSF WBC in pneumococcal meningitis is linked to sepsis and systemic complications.
  • Invasive pneumococcal infections may be viewed as a continuum from meningitis to sepsis.

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