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Bacterial meningitis with "normal" cerebrospinal fluid in adults: a report on five cases

P Domingo1, J Mancebo, L Blanch

  • 1Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain.

Scandinavian Journal of Infectious Diseases
|January 1, 1990
PubMed

Insights

Bacterial meningitis can be missed in adults if cerebrospinal fluid (CSF) tests are normal, especially when lumbar puncture is done early or white blood cell counts are low. Early diagnosis is crucial to prevent overlooking this serious infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Bacterial meningitis is a serious infection of the central nervous system.
  • Cerebrospinal fluid (CSF) analysis is key for diagnosing bacterial meningitis.
  • Diagnostic challenges arise in specific patient populations.

Purpose of the Study:

  • To describe cases of bacterial meningitis with normal CSF findings in adults.
  • To highlight diagnostic difficulties in early disease stages or with low peripheral white blood cell counts.

Main Methods:

  • Case series of five adult patients.
  • Review of clinical presentations and diagnostic workups.
  • Analysis of lumbar puncture timing and peripheral blood cell counts.

Main Results:

  • All five patients presented with bacterial meningitis but had normal CSF findings.
  • Lumbar punctures were performed early in disease progression for these patients.
  • Low peripheral white blood cell counts were noted in some cases.

Conclusions:

  • Normal CSF findings do not always rule out bacterial meningitis in adults.
  • Early lumbar puncture or low white blood cell counts can mask the diagnosis.
  • Clinicians must maintain a high index of suspicion for bacterial meningitis in challenging cases.

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