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Published on: August 12, 2020
Etiology and Laboratory Abnormalities in Bacterial Meningitis in Neonates and Young Infants
David Kotzbauer1, Curtis Travers1, Craig Shapiro1
1Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Abstract:
We conducted a retrospective review of electronic medical records of all cases of bacterial meningitis in neonates and young infants at our institution from 2004 to 2014. Fifty-six cases were identified. The most common causative organism was group B streptococcus, followed by Escherichia coli and then Listeria monocytogenes. Forty-four of the 56 patients in the study had abnormalities of the blood white blood cell (WBC) count. The most common WBC count abnormalities were leukopenia and elevation of the immature to total (I:T) neutrophil ratio. Six patients in the case series lacked cerebrospinal fluid (CSF) pleocytosis. Overall, just 3 of the 56 patients had normal WBC count with differential, CSF WBC count, and urinalysis. Only 1 of the 56 patients was well appearing with all normal lab studies. Our study indicates that bacterial meningitis may occur without CSF pleocytosis but very infrequently occurs with all normal lab studies and well appearance.
Insights
Bacterial meningitis in infants can present without cerebrospinal fluid (CSF) pleocytosis. However, it rarely occurs with normal blood work and a well appearance in neonates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Bacterial meningitis is a serious infection in neonates and young infants.
- Diagnosis can be challenging due to atypical presentations.
Purpose of the Study:
- To review cases of bacterial meningitis in neonates and young infants.
- To identify common causative organisms and diagnostic challenges.
Main Methods:
- Retrospective review of electronic medical records from 2004-2014.
- Analysis of 56 identified cases of bacterial meningitis.
Main Results:
- Group B Streptococcus was the most common pathogen, followed by Escherichia coli and Listeria monocytogenes.
- Abnormal white blood cell (WBC) counts were present in 44/56 patients, with leukopenia and elevated immature to total (I:T) neutrophil ratio being most common.
- Six patients lacked CSF pleocytosis; only one patient presented well with all normal laboratory studies.
Conclusions:
- Bacterial meningitis can occur without CSF pleocytosis.
- Normal laboratory findings and a well appearance are rare in confirmed cases of bacterial meningitis in this population.
