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Abstract:
Cerebrospinal fluid with a normal cell count, glucose and protein values, and a negative Gram's stain smear is usually assumed to exclude the possibility of meningitis. We describe four patients and review from literature 19 patients with pyogenic meningitis in whom the CSF initially appeared normal. Thus, finding minimal or no initial CSF abnormality is consistent with early or developing bacterial meningitis. Repeated lumbar puncture and CSF examination within 24 hours should be considered in all febrile patients in whom the clinical features remain compatible with meningitis.
Insights
Early bacterial meningitis can present with normal cerebrospinal fluid (CSF) findings. Consider repeat lumbar punctures in febrile patients with suspected meningitis if initial CSF analysis is unremarkable.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Meningitis diagnosis typically relies on cerebrospinal fluid (CSF) analysis.
- Normal CSF parameters (cell count, glucose, protein, Gram's stain) are often used to rule out meningitis.
Observation:
- This study reviewed 23 cases (4 presented, 19 from literature) of pyogenic meningitis.
- These patients initially presented with seemingly normal CSF.
- This highlights a potential diagnostic challenge in early-stage meningitis.
Findings:
- Minimal or absent initial CSF abnormalities can occur in early or developing bacterial meningitis.
- A normal initial CSF analysis does not reliably exclude pyogenic meningitis.
- The study identified a pattern of normal CSF in a subset of bacterial meningitis cases.
Implications:
- Clinicians should maintain a high index of suspicion for meningitis even with normal initial CSF results.
- Repeated lumbar puncture and CSF examination within 24 hours are crucial for febrile patients with persistent meningitis symptoms.
- This underscores the importance of serial CSF analysis in diagnosing meningitis, especially in its early stages.