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Nathan Kuppermann - One of the best experts on this subject based on the ideXlab platform.

  • sterile cerebrospinal fluid Pleocytosis in young febrile infants with urinary tract infections
    JAMA Pediatrics, 2011
    Co-Authors: Nathan Kuppermann, Charles G Macias, Stephen B Freedman, David Schnadower, Marc N Baskin, Paul Ishimine, Camille Scribner, Pamela J Okada, Heather Beach
    Abstract:

    Objectives To determine the prevalence of and to identify risk factors for sterile cerebrospinal fluid (CSF) Pleocytosis in a large sample of febrile young infants with urinary tract infections (UTIs) and to describe the clinical courses of those patients. Design Secondary analysis of a multicenter retrospective review. Setting Emergency departments of 20 North American hospitals. Patients Infants aged 29 to 60 days with temperatures of 38.0°C or higher and culture-proven UTIs who underwent a nontraumatic lumbar puncture from January 1, 1995, through May 31, 2006. Main Exposure Febrile UTI. Outcome Measures Presence of sterile CSF Pleocytosis defined as CSF white blood cell count of 10/μL or higher in the absence of bacterial meningitis and clinical course and treatment (ie, presence of adverse events, time to defervescence, duration of parenteral antibiotic treatment, and length of hospitalization). Results A total of 214 of 1190 infants had sterile CSF Pleocytosis (18.0%; 95% confidence interval, 15.9%-20.3%). Only the peripheral white blood cell count was independently associated with sterile CSF Pleocytosis, and patients with a peripheral white blood cell count of 15/μL or higher had twice the odds of having sterile CSF Pleocytosis (odds ratio, 1.97; 95% confidence interval, 1.32-2.94; P = .001). In the subset of patients at very low risk for adverse events (ie, not clinically ill in the emergency department and without a high-risk medical history), patients with and without sterile CSF Pleocytosis had similar clinical courses; however, patients with CSF Pleocytosis had longer parenteral antibiotics courses (median length, 4 days [interquartile range, 3-6 days] vs 3 days [interquartile range, 3-5 days]) (P = .04). Conclusion Sterile CSF Pleocytosis occurs in 18% of young infants with UTIs. Patients with CSF Pleocytosis at very low risk for adverse events may not require longer treatment with antibiotics.

  • cerebrospinal fluid Pleocytosis in children in the era of bacterial conjugate vaccines distinguishing the child with bacterial and aseptic meningitis
    Pediatric Emergency Care, 2009
    Co-Authors: Lise E. Nigrovic, Richard Malley, Nathan Kuppermann
    Abstract:

    Although bacterial meningitis remains an important cause of childhood morbidity and mortality, the incidence of bacterial meningitis has greatly decreased with the advent of polysaccharide-protein conjugate vaccines in the past 2 decades. Most children with cerebrospinal fluid Pleocytosis have aseptic rather than bacterial meningitis, raising the possibility that some patients may be managed as outpatients. In this article, we review the changing epidemiology of bacterial meningitis as well as the available clinical decision rules that may assist the clinician in distinguishing aseptic from bacterial meningitis in patients with cerebrospinal fluid Pleocytosis.

  • sterile cerebrospinal fluid Pleocytosis in young infants with urinary tract infections
    The Journal of Pediatrics, 2008
    Co-Authors: Samir S Shah, Joseph J Zorc, Deborah Levine, Shari L Platt, Nathan Kuppermann
    Abstract:

    In a multicenter prospective study, 91 of 1025 febrile infants ≤60 days of age had urinary tract infections. Among patients with urinary tract infections and without traumatic lumbar punctures, sterile cerebrospinal fluid Pleocytosis was uncommon (0%-8%, depending on the definition) in contrast to earlier studies reporting this association.

  • clinical prediction rule for identifying children with cerebrospinal fluid Pleocytosis at very low risk of bacterial meningitis
    JAMA, 2007
    Co-Authors: Lise E. Nigrovic, Nathan Kuppermann, Charles G Macias, Christopher R Cannavino, Donna M Morosutherland, Robert D Schremmer, Sandra H Schwab, Dewesh Agrawal, Karim M Mansour, Jonathan E Bennett
    Abstract:

    ContextChildren with cerebrospinal fluid (CSF) Pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics, although few have bacterial meningitis. We previously developed a clinical prediction rule, the Bacterial Meningitis Score, that classifies patients at very low risk of bacterial meningitis if they lack all of the following criteria: positive CSF Gram stain, CSF absolute neutrophil count (ANC) of at least 1000 cells/μL, CSF protein of at least 80 mg/dL, peripheral blood ANC of at least 10 000 cells/μL, and a history of seizure before or at the time of presentation.ObjectiveTo validate the Bacterial Meningitis Score in the era of widespread pneumococcal conjugate vaccination.Design, Setting, and PatientsA multicenter, retrospective cohort study conducted in emergency departments of 20 US academic medical centers through the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. All children aged 29 days to 19 years who presented at participating emergency departments between January 1, 2001, and June 30, 2004, with CSF Pleocytosis (CSF white blood cells ≥10 cells/μL) and who had not received antibiotic treatment before lumbar puncture.Main Outcome MeasureThe sensitivity and negative predictive value of the Bacterial Meningitis Score.ResultsAmong 3295 patients with CSF Pleocytosis, 121 (3.7%; 95% confidence interval [CI], 3.1%-4.4%) had bacterial meningitis and 3174 (96.3%; 95% CI, 95.5%-96.9%) had aseptic meningitis. Of the 1714 patients categorized as very low risk for bacterial meningitis by the Bacterial Meningitis Score, only 2 had bacterial meningitis (sensitivity, 98.3%; 95% CI, 94.2%-99.8%; negative predictive value, 99.9%; 95% CI, 99.6%-100%), and both were younger than 2 months old. A total of 2518 patients (80%) with aseptic meningitis were hospitalized.ConclusionsThis large multicenter study validates the Bacterial Meningitis Score prediction rule in the era of conjugate pneumococcal vaccine as an accurate decision support tool. The risk of bacterial meningitis is very low (0.1%) in patients with none of the criteria. The Bacterial Meningitis Score may be helpful to guide clinical decision making for the management of children presenting to emergency departments with CSF Pleocytosis.

  • cerebrospinal fluid Pleocytosis and prognosis in invasive meningococcal disease in children
    Pediatric Infectious Disease Journal, 1998
    Co-Authors: Richard Malley, Stanley H Inkelis, Peter Coelho, W C Huskins, Nathan Kuppermann
    Abstract:

    Background.The absence of cerebrospinal fluid (CSF) Pleocytosis in invasive meningococcal disease (IMD) has been associated with an increased risk of death. It is unknown whether patients who lack a cellular response to central nervous system (CNS) infection are at the same risk of adverse outcome a

Ase Bengard Andersen - One of the best experts on this subject based on the ideXlab platform.

  • cerebrospinal fluid Pleocytosis level as a diagnostic predictor a cross sectional study
    BMC Clinical Pathology, 2017
    Co-Authors: Anne Ahrens Ostergaard, Thomas Vognbjerg Sydenham, Mads Nybo, Ase Bengard Andersen
    Abstract:

    Background Lumbar puncture with quantification of leukocytes and differential count of cellular subsets in the cerebrospinal fluid is a standard procedure in cases of suspected neuroinfectious conditions. However, a number of non-infectious causes may result in a low leukocyte number (0-1000 cells/ml). We wanted to assess the diagnostic diversity of unselected adult patients with Pleocytosis in the cerebrospinal fluid. Methods The study is based on data from cerebrospinal fluid (CSF) analyses of all adult patients (15 years or older) admitted to a large university hospital in Denmark during a two-year period (2008-2009). Data from the local patient administrative system supplied with data from patient charts were combined with laboratory data. Results A total of 5390 cerebrospinal fluid samples from 3290 patients were included. Pleocytosis >5 leucocytes/μl was found in samples from 262 patients of which 106 (40.5%) were caused by infection of the central nervous system (CNS), 20 (7.6%) by infection outside CNS, 79 (30.2%) due to non-infectious neurological diseases, 23 (8.8%) by malignancy, and 34 (13.0%) caused by other conditions. Significantly higher mean CSF leukocytes was found in patients suffering from CNS infection (mean 1135 cells/μl, p-value Conclusions CNS infection, non-infectious neurological disease, malignancy, and infection outside CNS can cause Pleocytosis of the cerebrospinal fluid. Leukocyte counts above 100/μl is mainly caused by CNS infection, whereas the number of differential diagnoses is higher if the CSF leukocyte counts is below 50/μl. These conditions are most commonly caused by non-infectious neurological diseases including seizures.

  • cerebrospinal fluid Pleocytosis level as a diagnostic predictor a cross sectional study
    BMC Clinical Pathology, 2017
    Co-Authors: Anne Ahrens Ostergaard, Thomas Vognbjerg Sydenham, Mads Nybo, Ase Bengard Andersen
    Abstract:

    Lumbar puncture with quantification of leukocytes and differential count of cellular subsets in the cerebrospinal fluid is a standard procedure in cases of suspected neuroinfectious conditions. However, a number of non-infectious causes may result in a low leukocyte number (0–1000 cells/ml). We wanted to assess the diagnostic diversity of unselected adult patients with Pleocytosis in the cerebrospinal fluid. The study is based on data from cerebrospinal fluid (CSF) analyses of all adult patients (15 years or older) admitted to a large university hospital in Denmark during a two-year period (2008–2009). Data from the local patient administrative system supplied with data from patient charts were combined with laboratory data. A total of 5390 cerebrospinal fluid samples from 3290 patients were included. Pleocytosis >5 leucocytes/μl was found in samples from 262 patients of which 106 (40.5%) were caused by infection of the central nervous system (CNS), 20 (7.6%) by infection outside CNS, 79 (30.2%) due to non-infectious neurological diseases, 23 (8.8%) by malignancy, and 34 (13.0%) caused by other conditions. Significantly higher mean CSF leukocytes was found in patients suffering from CNS infection (mean 1135 cells/μl, p-value <0.0001). CNS infection, non-infectious neurological disease, malignancy, and infection outside CNS can cause Pleocytosis of the cerebrospinal fluid. Leukocyte counts above 100/μl is mainly caused by CNS infection, whereas the number of differential diagnoses is higher if the CSF leukocyte counts is below 50/μl. These conditions are most commonly caused by non-infectious neurological diseases including seizures.

Samir S Shah - One of the best experts on this subject based on the ideXlab platform.

Nigel Curtis - One of the best experts on this subject based on the ideXlab platform.

  • bacterial meningitis in the absence of Pleocytosis in children a systematic review
    Pediatric Infectious Disease Journal, 2021
    Co-Authors: Petra Zimmermann, Nigel Curtis
    Abstract:

    One of the main features of bacterial meningitis is Pleocytosis. However, when children with meningitis present within hours of onset of symptoms, there is the possibility that the meninges are not yet sufficiently inflamed to lead to a raised cerebrospinal fluid (CSF) white blood cell count. A systematic search was done to identify published studies reporting children with culture- or polymerase chain reaction-proven bacterial meningitis in the absence of Pleocytosis. We identified 26 studies describing 62 children (18 neonates). In those in whom fever duration was specified, 32 (80%) of 40 had a fever for less than or equal to 24 hours before lumbar puncture (LP). In those in whom the glucose level was reported, it was normal in 14 (82%) of 17 neonates and 33 (80%) of 41 older infants and children. The protein level was normal in 8 (44%) of 17 neonates and 32 (80%) of 40 older infants and children. Twelve of the 62 children had a Gram stain of their CSF and this was positive in 2 (17%). Simultaneous blood cultures were positive in 5 (28%) of 18 neonates and 21 (68%) of 31 older infants and children. There was no association between the absence of Pleocytosis and particular bacteria. All of the 10 children who had a second LP had an abnormal CSF including Pleocytosis. These findings indicate that the absence of Pleocytosis does not exclude bacterial meningitis reliably and should be interpreted in the context of the duration of illness. CSF samples, particularly those from cases with relatively short symptom duration, should be cultured even when the cell count and biochemistry are normal. A second LP can be helpful when bacterial meningitis is suspected despite a normal initial CSF.

  • question 1 do febrile convulsions cause csf Pleocytosis
    Archives of Disease in Childhood, 2012
    Co-Authors: Gabrielle M Haeusler, Marc Tebruegge, Nigel Curtis
    Abstract:

    You are asked to review a previously healthy 11-month-old boy who presented to the Accident and Emergency department following a generalised convulsion lasting 7 min. His parents tell you that he was started on oral amoxicillin by his general practitioner 2 days ago, the reason for which is unclear. Clinical examination reveals a drowsy child with a temperature of 38.8°C. In the absence of a clear focus of infection you decide to do a full septic screen, including a lumbar puncture (LP). Cerebrospinal fluid (CSF) analysis shows a white blood cell count (WCC) of 17×106/l, a protein concentration within normal limits and no bacteria on a Gram stain. You wonder if the mild CSF Pleocytosis indicates partially treated meningitis or can be attributed to the convulsion alone. In a child with a febrile convulsion [patient], does the convulsion alone [intervention] cause CSF Pleocytosis (defined as CSF WCC>7×106/l) [outcome]? Medline was searched with the PubMed interface (1950 to present, limited to publications in English) using the search terms: (epilepsy OR convulsion OR seizure) AND (cerebrospinal fluid OR lumbar puncture OR blood brain barrier) AND (leukocyte OR leukocytosis OR Pleocytosis OR white blood cell OR cell count). This produced 357 matches, of which five were relevant.1,–,5 Searches of EMBASE (1970 to present; 1012 matches) and Scopus (1960 to present; 717 matches) using the same search strategy did not identify any additional papers. All relevant publications were hand-searched for further references, which identified a further four relevant reports.6,–,9 In instances where the original manuscript provided insufficient information, the authors were contacted for further details. The search date was 1 May 2011. The relevant papers are summarised …

Beyong Il Kim - One of the best experts on this subject based on the ideXlab platform.

  • enteroviral meningitis without Pleocytosis in children
    Archives of Disease in Childhood, 2012
    Co-Authors: Ki Wook Yun, Eun Hwa Choi, Doo Sung Cheon, Jina Lee, Chang Won Choi, Hee Hwang, Beyong Il Kim
    Abstract:

    Objectives This study aims to describe the clinical characteristics of enteroviral meningitis in association with the absence of cerebrospinal fluid (CSF) Pleocytosis. Design This was a retrospective analysis of databases of patients diagnosed with enteroviral meningitis by CSF reverse transcription-PCR testing. Presence of CSF non-Pleocytosis at each age group was analysed by use of the two criteria. Clinical variables were compared with regard to the presence of CSF Pleocytosis. Multiple logistic regression analysis was used to identify factors that were associated with CSF Pleocytosis. Setting Two hospitals in South Korea, between January 2008 and August 2011. Patients 390 infants and children with enteroviral meningitis. Interventions None. Main outcome measures Proportion of enteroviral meningitis without CSF Pleocytosis. Results Among the 390 patients with enteroviral meningitis, 16–18% did not have CSF Pleocytosis. In particular, CSF Pleocytosis was not present in 68–77% of the neonates with enteroviral meningitis, demonstrating that the proportion of CSF Pleocytosis decreased significantly with age (p Conclusions This study demonstrated high proportion of non-pleocytic enteroviral meningitis in young infants and identified several clinical factors that contributed to the absence of CSF Pleocytosis. We suggest that CSF enterovirus PCR testing is likely to detect more cases of enteroviral meningitis, especially in young infants.