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Prediction of bacterial meningitis based on cerebrospinal fluid pleocytosis in children

Sofia Águeda1, Teresa Campos, Ana Maia

  • 1Department of Pediatrics, Centro Hospitalar São João, EPE, Porto, Portugal. sofiamsa@gmail.com

The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases
|April 23, 2013
PubMed

Insights

A cerebrospinal fluid white blood cell count cutoff of 321 cells/μL can help distinguish bacterial meningitis from viral or aseptic causes in children. This rapid test aids in diagnosing pediatric meningitis, reducing unnecessary antibiotic use.

Area of Science:

  • Pediatric Infectious Diseases
  • Clinical Microbiology
  • Diagnostic Medicine

Background:

  • Children with cerebrospinal fluid (CSF) pleocytosis often receive antibiotics, despite bacterial meningitis being infrequent.
  • Existing clinical prediction rules exist, but CSF white blood cell (WBC) count is an early available metric.
  • Differentiating bacterial from viral and aseptic meningitis is crucial for appropriate treatment.

Purpose of the Study:

  • To establish a CSF white blood cell count cutoff value to differentiate bacterial meningitis from viral and aseptic meningitis in children.
  • To evaluate the diagnostic utility of CSF WBC count for pediatric meningitis.

Main Methods:

  • Retrospective study of 295 children (29 days to 17 years) with CSF pleocytosis (WBC ≥ 7/μL).
  • Exclusion of cases with traumatic lumbar puncture or pre-lumbar puncture antibiotic treatment.
  • Analysis of CSF WBC counts in patients diagnosed with bacterial, viral, or aseptic meningitis.

Main Results:

  • Bacterial meningitis (10.5%) had significantly higher CSF WBC counts (mean 4839 cells/μL) compared to aseptic (mean 159 cells/μL) and viral meningitis (mean 577 cells/μL).
  • A CSF WBC cutoff of 321 cells/μL demonstrated optimal sensitivity (80.6%) and specificity (81.4%) for bacterial meningitis diagnosis.
  • The area under the receiver operating characteristic curve was 0.837, indicating good diagnostic performance.

Conclusions:

  • CSF white blood cell count is a valuable and rapid diagnostic tool for distinguishing bacterial from non-bacterial meningitis in children.
  • The established cutoff of 321 WBC/μL can aid clinicians in making timely treatment decisions.
  • This finding supports the use of CSF WBC count as an initial diagnostic test in pediatric meningitis evaluations.

Keywords:
Bacterial meningitisCutoff pointPleocytosis

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