PMID: 7023410Sep 1, 1981Paper

Bacterial meningitis in the absence of CSF pleocytosis

Archives of Internal Medicine
D B FishbeinW P Reed

Abstract

Two cases of acute bacterial meningitis occurred with an absent CSF WBC response. To determine the incidence and clinical characteristics of such patients, 50 consecutive cases of meningitis were reviewed retrospectively. In addition to the two initially noted cases, five additional cases were found. In the seven cases, there were six or fewer cells, but bacteria were detected in the CSF. A distinctive clinical and laboratory syndrome emerged. All seven patients were either old or had Hodgkin's disease or severe alcoholism. All patients had evidence of an overwhelming infection with confusion or nuchal rigidity. As compared with the remaining 45 patients with meningitis and CSF pleocytosis, no fever (less than 38 degrees C), a lower peripheral WBC count, and near-normal CSF glucose and protein concentrations were common. Organisms involved were EScherichia coli in three patients, Pneumococcus in three patients, and mixed anaerobes in patient. A fatal outcome ensued in six of seven patients. Despite the correct choice of an antibacterial agent, doses were late and suboptimal for meningitis. This syndrome is surprisingly common in host-defective cases, has an ominous prognosis, and must be treated expectantly with antimicrobial a...Continue Reading

Citations

Jan 1, 2014·Journal of Medical Case Reports·Hiromichi SuzukiHidenori Nakamura
Apr 2, 2003·Expert Opinion on Therapeutic Targets·Kwang Sik Kim
Feb 13, 2018·Journal of Investigative Medicine High Impact Case Reports·Hassan MehmoodAsghar Marwat
Dec 28, 2007·The Korean journal of laboratory medicine·Sook Won Ryu, In Bum Suh
May 3, 2003·Nature Reviews. Neuroscience·Kwang Sik Kim
Jun 1, 1988·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·L LindquistG Axelsson

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