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Bacterial meningitis with initial normal cerebrospinal fluid findings.
J Rosenthal1, A Golan, R Dagan
1Department of Pediatrics, Soroka Medical Center, Beer Sheva, Israel.
Israel Journal of Medical Sciences
|April 1, 1989
Summary
Bacterial meningitis in children can present with normal cerebrospinal fluid (CSF) findings, occurring in 6.5% of cases. This condition, despite early antibiotic treatment, is associated with a high fatality rate.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Bacterial meningitis is a serious infection of the central nervous system.
- Cerebrospinal fluid (CSF) analysis is crucial for diagnosing bacterial meningitis.
- Initial normal CSF findings in suspected bacterial meningitis are uncommon but clinically significant.
Purpose of the Study:
- To report on pediatric cases of bacterial meningitis with initially normal CSF findings.
- To evaluate the clinical characteristics and outcomes of these patients.
- To highlight the potential for poor prognosis in such cases.
Main Methods:
- Retrospective case series of pediatric patients diagnosed with bacterial meningitis.
- Inclusion criteria: initial normal CSF findings on lumbar puncture.
- Data collection: symptom duration, treatment, and case-fatality rate.
Main Results:
- Seven pediatric patients (6.5% of total bacterial meningitis cases) presented with normal initial CSF.
- Short symptom duration (6-24 hours) prior to lumbar puncture in all cases.
- High case-fatality rate of 43% (3/7) compared to 10% in patients with abnormal initial CSF.
Conclusions:
- Bacterial meningitis with normal initial CSF findings is not a rare occurrence in pediatric patients.
- This presentation is associated with a significantly higher case-fatality rate.
- Early diagnosis and treatment may be challenged by normal initial CSF, necessitating heightened clinical suspicion.