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Meningococcal meningitis with 'normal' cerebrospinal fluid
Abstract:
A prospective study was made of all patients with normal CSF counts and positive cultures for Neisseria meningitidis diagnosed in "El Vallés" County, Barcelona between January 1987 and December 1990. Meningococcal meningitis was documented in 82 patients, eight of whom (seven children, five boys and two girls with a mean age of 5.6 +/- 3.3 years, and a 69-year-old male patient) had no apparent CSF abnormalities in the initial lumbar puncture. At the time of admission all patients had fever (mean 39.1 degrees C) of 10.8 +/- 5.6 hour duration and petechial rash which had been present for a mean of 3.6 +/- 3.3 hours. Signs of meningeal irritation were not found. A 4-month-old infant with symptoms of circulatory collapse, intracranial hypertension and impairment of consciousness subsequently died of septicemia in 48 hours. Group B N. meningitidis was isolated in six cases (reduced penicillin-susceptibility in two cases) and group C N. meningitidis in the remaining two (reduced penicillin-susceptibility in one case). Patients without pleocytosis did not differ in a statistically significant fashion from the patients with high pleocytosis in the duration of temperature, and petechial rash, leukopenia, positive blood culture and fatal outcome.
Insights
Meningococcal meningitis can present without cerebrospinal fluid (CSF) abnormalities. This study found that patients with normal CSF counts and fever/rash had similar outcomes to those with elevated CSF counts, highlighting a diagnostic challenge.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Meningococcal meningitis is a serious infection, typically characterized by cerebrospinal fluid (CSF) abnormalities.
- Early diagnosis and treatment are crucial for favorable outcomes.
Purpose of the Study:
- To investigate cases of meningococcal meningitis presenting with normal CSF counts.
- To compare clinical features and outcomes of patients with and without CSF abnormalities.
Main Methods:
- Prospective study of patients diagnosed with Neisseria meningitidis infection.
- Analysis of clinical data including CSF analysis, symptoms, and outcomes.
- Comparison of patient groups based on CSF pleocytosis.
Main Results:
- Eight out of 82 patients with meningococcal meningitis had normal initial CSF counts.
- Patients without CSF abnormalities showed similar fever duration, rash, leukopenia, and fatality rates compared to those with pleocytosis.
- Group B Neisseria meningitidis was the most common isolate, with some cases showing reduced penicillin susceptibility.
Conclusions:
- Meningococcal meningitis can manifest without typical CSF pleocytosis, posing diagnostic challenges.
- Clinical presentation (fever, rash) and outcomes are not significantly different between patients with and without CSF abnormalities.
- Prompt recognition of meningococcal disease is vital, even with unremarkable initial CSF findings.