Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022.
Details
State: Public
Version: Final published version
License: CC BY-NC-ND 4.0
Serval ID
serval:BIB_813AC96CA58E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022.
Journal
International journal of infectious diseases
Working group(s)
French Pediatric Meningitis Network
ISSN
1878-3511 (Electronic)
ISSN-L
1201-9712
Publication state
Published
Issued date
12/2024
Peer-reviewed
Oui
Volume
149
Pages
107256
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
We aimed to describe cases of acute bacterial meningitis (ABM) without cerebrospinal fluid (CSF) pleocytosis and the clinical and biological characteristics of affected children.
We analyzed results of a nation-wide population-based prospective surveillance study of acute ABM in children aged 3 months to 15 years in France. Absence of CSF pleocytosis was defined as CSF leukocyte count ≤5/mm <sup>3</sup> .
We included 4754 cases of acute ABM from 2001 to 2022: 173 patients (3.6%) did not have CSF pleocytosis. ABM cases without CSF pleocytosis were mainly related to meningococcus (70% vs 44% with CSF pleocytosis, P <0.001). When performed in CSF with normal leukocyte count, Gram staining results were positive for 33%, culture for 80%, polymerase chain reaction results for 41%, and antigen detection for 20% of cases. Case fatality rate was higher for cases without than those with CSF pleocytosis (18% vs 6%, P <0.001). On multivariate analysis, absence of CSF pleocytosis was associated only with seizures before hospital arrival (adjusted odds ratio 2.3, 95% confidence interval 1.2-4.6, P <0.01).
ABM without CSF pleocytosis is infrequent but not exceptional, particularly in children with seizures before hospital arrival. Extended vaccination against meningococcus could prevent this clinical form with a high case fatality rate.
We analyzed results of a nation-wide population-based prospective surveillance study of acute ABM in children aged 3 months to 15 years in France. Absence of CSF pleocytosis was defined as CSF leukocyte count ≤5/mm <sup>3</sup> .
We included 4754 cases of acute ABM from 2001 to 2022: 173 patients (3.6%) did not have CSF pleocytosis. ABM cases without CSF pleocytosis were mainly related to meningococcus (70% vs 44% with CSF pleocytosis, P <0.001). When performed in CSF with normal leukocyte count, Gram staining results were positive for 33%, culture for 80%, polymerase chain reaction results for 41%, and antigen detection for 20% of cases. Case fatality rate was higher for cases without than those with CSF pleocytosis (18% vs 6%, P <0.001). On multivariate analysis, absence of CSF pleocytosis was associated only with seizures before hospital arrival (adjusted odds ratio 2.3, 95% confidence interval 1.2-4.6, P <0.01).
ABM without CSF pleocytosis is infrequent but not exceptional, particularly in children with seizures before hospital arrival. Extended vaccination against meningococcus could prevent this clinical form with a high case fatality rate.
Keywords
Humans, Child, Preschool, Child, Female, Meningitis, Bacterial/epidemiology, Meningitis, Bacterial/cerebrospinal fluid, Meningitis, Bacterial/diagnosis, Meningitis, Bacterial/microbiology, Meningitis, Bacterial/mortality, Infant, Leukocytosis/cerebrospinal fluid, Leukocytosis/epidemiology, Male, Prospective Studies, Adolescent, France/epidemiology, Acute Disease, Leukocyte Count, Population Surveillance, Cerebrospinal Fluid/microbiology, Acute bacterial meningitis, Cerebrospinal fluid, Pleocytosis
Pubmed
Web of science
Open Access
Yes
Create date
11/10/2024 14:13
Last modification date
11/12/2024 8:18
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