A systematic review of cases of meningitis in the absence of cerebrospinal fluid pleocytosis on lumbar puncture

BMC Infectious Diseases
Michelle Troendle, Alexis Pettigrew

Abstract

Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic clue of meningitis is pleocytosis on CSF analysis. However, meningitis may occur in the absence of pleocytosis on CSF. Areas of Uncertainty: A diagnosis of meningitis seems less likely without pleocytosis on CSF, leading clinicians to prematurely exclude this. Further, there is little available literature on the subject. Ovid/Medline and Google Scholar search was conducted for cases of CSF culture-confirmed meningitis with lack of pleocytosis. Inclusion criterion was reported cases of CSF culture-positive or PCR positive meningitis in the absence of pleocytosis on LP. Exclusion criteria were pleocytosis on CSF, cases in which CSF cultures/PCR were not performed, and articles that did not include CSF laboratory values. A total of 124 cases from 51 articles were included. Causative organisms were primarily bacterial (99 cases). Outcome was reported in 86 cases, 27 of which died and 59 survived. Mortality in viral, fungal and bacterial organisms was 0, 56 and 31%, respectively. The overall percentage of positive initial CSF PC...Continue Reading

References

Jul 1, 1978·Archives of Disease in Childhood·A D Kindley, F Harris
Aug 1, 1976·Archives of Disease in Childhood·J Z Heckmatt
Jan 1, 1992·Clinical Neurology and Neurosurgery·A DaifM AbdulJabbar
Feb 1, 1991·Pediatric Emergency Care·U M Sankrithi, J J LiPuma
Sep 1, 1990·Pediatric Emergency Care·M A HegenbarthE G Chadwick
Mar 1, 1990·Southern Medical Journal·D M Bamberger, O J Smith
Jan 1, 1990·Scandinavian Journal of Infectious Diseases·P DomingoJ Nolla
Nov 1, 1989·The Journal of Infectious Diseases·S ShaunakJ R Perfect
Jan 3, 1987·Lancet·R A HaywardR K Oye
Aug 1, 1984·Archives of Neurology·G J GorseT C Cesario
Oct 29, 1981·The New England Journal of Medicine·D W TeeleJ O Klein
Nov 1, 1994·The Journal of Infection·M T CollJ Lite
Nov 1, 1995·The Journal of Infection·M P Lessing, I C Bowler
Jan 1, 1996·European Neurology·T UchiharaH Tsukagoshi
Jun 1, 1997·Clinical Pediatrics·M Sivakmaran
Apr 2, 1999·The American Journal of Emergency Medicine·A Gutiérrez-MacíasM Martinez-Ortiz de Zarate
Jun 27, 2003·Lancet·Xavier Sáez-Llorens, George H McCracken
Sep 6, 2005·Médecine et maladies infectieuses·Isabelle Rebeu-DartiguelongueJean Campistron
May 17, 2007·Pediatric Emergency Care·Manoj K MittalEron Y Friedlaender
Mar 1, 2008·Kansenshōgaku zasshi. The Journal of the Japanese Association for Infectious Diseases·Kensuke NagaiKoji Hashimoto
Jul 16, 2010·Journal of Hospital Medicine : an Official Publication of the Society of Hospital Medicine·Samir S ShahJoseph J Zorc
Aug 20, 2010·Indian Journal of Pediatrics·Kirandeep Sodhi Chandrashekhar
May 6, 2011·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Emmanuel MontassierGilles Potel
Dec 14, 2011·Emergency Medicine Australasia : EMA·Judith E Tintinalli
Apr 23, 2013·The Brazilian Journal of Infectious Diseases : an Official Publication of the Brazilian Society of Infectious Diseases·Sofia ÁguedaAna Maia
Jan 1, 2014·Journal of Medical Case Reports·Hiromichi SuzukiHidenori Nakamura
Jul 19, 2014·BMJ Case Reports·Naghum DawoodMichael Jacobs
Nov 6, 2014·The Canadian Journal of Infectious Diseases & Medical Microbiology = Journal Canadien Des Maladies Infectieuses Et De La Microbiologie Médicale·Ryota HaseKiyoharu Muranaka
Dec 3, 2014·Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi·Wen-Li LinNan-Chang Chiu
Apr 24, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Matthijs C Brouwer, Diederik van de Beek
Nov 1, 2015·The American Journal of Emergency Medicine·Ryota SatoYusuke Kitahara
Jan 24, 2016·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·Joost M CosterusD van de Beek
Aug 28, 2016·The American Journal of Emergency Medicine·Michelle Troendle, Deanna Willis
Nov 29, 2016·Indian Journal of Sexually Transmitted Diseases and AIDS·Soaham Dilip DesaiBhalendu Vaishnav
Apr 10, 2018·Médecine et maladies infectieuses·M MartinotJ-D Kaiser

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Citations

Feb 13, 2021·Open Forum Infectious Diseases·Mathieu WaldMartin Martinot
Feb 10, 2021·Journal of the Neurological Sciences·Ariane LewisKara R Melmed
Jan 23, 2020·Seminars in Ultrasound, CT, and MR·Ivy NguyenShan Li

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Methods Mentioned

BETA
PCR
blood draw

Software Mentioned

/ Medline
Google Scholar
Ovid

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