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The Lancet. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
[Source: The Lancet, full text: (LINK). Abstract, edited.]
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The Lancet, Volume 380, Issue 9854, Pages 1684 - 1692, 10 November 2012
doi:10.1016/S0140-6736(12)61185-4
This article can be found in the following collections: Infectious Diseases (Neurological infections, Paediatric infections); Neurology (Neurological infections); Paediatrics (Paediatric infections)
Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Original Text
Matthijs C Brouwer MD a, Guy E Thwaites MD b c, Prof Allan R Tunkel MD d, Prof Diederik van de Beek MD a
Summary
Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
a Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; b Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK; c Guy's and St Thomas' NHS Foundation Trust, London, UK; d Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
Correspondence to: Prof Diederik van de Beek, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, PO Box 22660, 1100DD Amsterdam, Netherlands
-doi:10.1016/S0140-6736(12)61185-4
This article can be found in the following collections: Infectious Diseases (Neurological infections, Paediatric infections); Neurology (Neurological infections); Paediatrics (Paediatric infections)
Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Original Text
Matthijs C Brouwer MD a, Guy E Thwaites MD b c, Prof Allan R Tunkel MD d, Prof Diederik van de Beek MD a
Summary
Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
a Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; b Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK; c Guy's and St Thomas' NHS Foundation Trust, London, UK; d Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
Correspondence to: Prof Diederik van de Beek, Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, PO Box 22660, 1100DD Amsterdam, Netherlands
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