Repeat lumbar puncture in adults with bacterial meningitis

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
Joost M CosterusDiederik van de Beek

Abstract

In a prospective nationwide cohort study performed in the Netherlands from 2006 to 2014 we analysed clinical and laboratory characteristics of adults with community-acquired bacterial meningitis who underwent repeat lumbar puncture. Repeat lumbar puncture was performed in 124 of 1490 included episodes (8%), most commonly because of clinical deterioration (42%). Median cerebrospinal fluid (CSF) leucocyte count on admission was 1473 cells/mm(3). Median CSF cell count showed a decrease of 19% when repeated within 2 days; of 84% within 3-7 days, of 93% within 8-14 days and of 98% within 15-21 days. Repeat lumbar puncture confirmed the diagnosis of meningitis in eight patients with normal initial CSF examination. Repeat CSF cultures yielded bacteria in nine patients, which led to identification of an underlying source of infection in two. We conclude that repeat lumbar puncture is performed in a small proportion of adults. Although it should not be seen as routine it can be useful in selected cases to confirm diagnosis, to exclude relapsing or persistent infection, or for therapeutic purpose in communicating hydrocephalus.

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Citations

Jul 13, 2016·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·M GlimåkerJ Sjölin
Aug 4, 2016·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·J M CosterusD van de Beek
Nov 7, 2016·Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases·S P DiasD van de Beek
Jul 10, 2018·Journal of Child Neurology·Madelein GrobbelaarRegan Solomons
Jul 3, 2020·Journal of Veterinary Internal Medicine·Hayley ChidlowErin McConachie Beasley
Aug 5, 2020·Annals of Emergency Medicine·Hannah Holm VestergaardJacob Bodilsen
Jan 19, 2021·Acta Clinica Belgica·Sofie DepoortereDimitri Hemelsoet
Feb 13, 2021·Open Forum Infectious Diseases·Mathieu WaldMartin Martinot
Jun 23, 2021·Expert Opinion on Pharmacotherapy·Marise BremerAngharad G Davis

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