TY - JOUR
T1 - Bacterial meningitis presenting with a normal cerebrospinal fluid leukocyte count
AU - van Soest, Thijs M.
AU - Chekrouni, Nora
AU - van Sorge, Nina M.
AU - Brouwer, Matthijs C.
AU - van de Beek, Diederik
N1 - Funding Information: Financial support. This work was supported by the Netherlands Organization for Health Research and Development (ZonMw; NWO-Vidi Grant [grant number 917.17.308 to M. B.], NWO-Vici-Grant [grant number 918.19.627 to D. B.]); the Academic Medical Center (AMC Fellowship to D. B.); and the European Research Council (ERC Consolidator grant to M.C.B., ERC Starting grant to D. B.). The Netherlands Reference Laboratory for Bacterial Meningitis is supported by the National Institute of Public health and the Environmental Protection, Bilthoven . Publisher Copyright: © 2022 The Authors
PY - 2022/5
Y1 - 2022/5
N2 - Objectives: We describe clinical characteristics and outcome of adults with bacterial meningitis presenting with a normal CSF leukocyte count. Methods: We studied community-acquired bacterial meningitis with a normal CSF leukocyte count (≤ 5 per mm3) in adults from a prospective nationwide cohort study. Results: From 2006 through 2020, 39 of 2,357 (2%) episodes presented with a normal CSF leukocyte count. Immunocompromising conditions were present in 19 of 39 patients (49%), compared to 690 of 2303 (30%) in patients with elevated leukocytes (P = 0.02). The triad of fever, neck stiffness, and altered consciousness was present in 6 of 34 patients (18%). CSF protein was abnormal in 25 of 37 patients (68%). We identified 3 clinical subgroups: those with severe pneumococcal meningitis (20 patients [51%]), with mainly sepsis (8 [21%]), and a miscellaneous group (11 [28%]). All patients with severe pneumococcal meningitis presented with high CSF protein levels and 18 of 19 (95%) had bacteria in the CSF Gram stain. Outcome was unfavorable in 23 of 39 (59%) patients and 12 (31%) died. Conclusion: Patients with bacterial meningitis may present with normal CSF leukocyte counts. In these patients, CSF protein levels and Gram staining are important diagnostic parameters.
AB - Objectives: We describe clinical characteristics and outcome of adults with bacterial meningitis presenting with a normal CSF leukocyte count. Methods: We studied community-acquired bacterial meningitis with a normal CSF leukocyte count (≤ 5 per mm3) in adults from a prospective nationwide cohort study. Results: From 2006 through 2020, 39 of 2,357 (2%) episodes presented with a normal CSF leukocyte count. Immunocompromising conditions were present in 19 of 39 patients (49%), compared to 690 of 2303 (30%) in patients with elevated leukocytes (P = 0.02). The triad of fever, neck stiffness, and altered consciousness was present in 6 of 34 patients (18%). CSF protein was abnormal in 25 of 37 patients (68%). We identified 3 clinical subgroups: those with severe pneumococcal meningitis (20 patients [51%]), with mainly sepsis (8 [21%]), and a miscellaneous group (11 [28%]). All patients with severe pneumococcal meningitis presented with high CSF protein levels and 18 of 19 (95%) had bacteria in the CSF Gram stain. Outcome was unfavorable in 23 of 39 (59%) patients and 12 (31%) died. Conclusion: Patients with bacterial meningitis may present with normal CSF leukocyte counts. In these patients, CSF protein levels and Gram staining are important diagnostic parameters.
KW - Bacterial meningitis
KW - Leukocytosis
KW - Outcome
KW - Prospective cohort study
KW - Signs and symptoms
UR - http://www.scopus.com/inward/record.url?scp=85126136268&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jinf.2022.02.029
DO - https://doi.org/10.1016/j.jinf.2022.02.029
M3 - Article
C2 - 35245581
SN - 0163-4453
VL - 84
SP - 615
EP - 620
JO - Journal of Infection
JF - Journal of Infection
IS - 5
ER -