Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022
Objectives: We aimed to describe cases of acute bacterial meningitis (ABM) without cerebrospinal fluid (CSF) pleocytosis and the clinical and biological characteristics of affected children. Methods: We analyzed results of a nation-wide population-based prospective surveillance study of acute ABM in...
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Elsevier
2024-12-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224003278 |
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| author | Lama Jaber Corinne Levy Naïm Ouldali Emmanuelle Varon Muhamed-Kheir Taha Stéphane Bonacorsi Stéphane Béchet François Angoulvant Robert Cohen Alexis Rybak |
| author_facet | Lama Jaber Corinne Levy Naïm Ouldali Emmanuelle Varon Muhamed-Kheir Taha Stéphane Bonacorsi Stéphane Béchet François Angoulvant Robert Cohen Alexis Rybak |
| author_sort | Lama Jaber |
| collection | DOAJ |
| description | Objectives: We aimed to describe cases of acute bacterial meningitis (ABM) without cerebrospinal fluid (CSF) pleocytosis and the clinical and biological characteristics of affected children. Methods: 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/mm3. Results: 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). Conclusions: 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. |
| format | Article |
| id | doaj-art-97e89221f6a84f9a93d12bddeb6e0ac7 |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-97e89221f6a84f9a93d12bddeb6e0ac72024-11-29T06:23:08ZengElsevierInternational Journal of Infectious Diseases1201-97122024-12-01149107256Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022Lama Jaber0Corinne Levy1Naïm Ouldali2Emmanuelle Varon3Muhamed-Kheir Taha4Stéphane Bonacorsi5Stéphane Béchet6François Angoulvant7Robert Cohen8Alexis Rybak9Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris Cité, Paris, FranceACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est Créteil, Créteil, France; GEMINI, Groupe de Recherche Clinique-Groupe d'Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Créteil, FranceAssistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris Cité, Paris, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; IAME, Infection, Antimicrobials, Modelling, Evolution, UMR 1137, INSERM, Université Paris Cité, Paris, FranceLaboratory of Microbiology and National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est Créteil, Créteil, FranceInvasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Institut Pasteur, Paris, FranceLaboratory of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris Cité, Paris, FranceACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, FranceGPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Department of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne, SwitzerlandACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Research Center, Centre Hospitalier Intercommunal de Créteil, Université Paris-Est Créteil, Créteil, France; GEMINI, Groupe de Recherche Clinique-Groupe d'Etude des Maladies Infectieuses Néonatales et Infantiles, Institut Mondor de Recherche Biomédicale, Créteil, FranceACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Department of Pediatrics, Department Woman-Mother-Child, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois), Lausanne, Switzerland; Corresponding author: Tel.: +33148850404.Objectives: We aimed to describe cases of acute bacterial meningitis (ABM) without cerebrospinal fluid (CSF) pleocytosis and the clinical and biological characteristics of affected children. Methods: 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/mm3. Results: 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). Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S1201971224003278Acute bacterial meningitisPleocytosisCerebrospinal fluid |
| spellingShingle | Lama Jaber Corinne Levy Naïm Ouldali Emmanuelle Varon Muhamed-Kheir Taha Stéphane Bonacorsi Stéphane Béchet François Angoulvant Robert Cohen Alexis Rybak Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 International Journal of Infectious Diseases Acute bacterial meningitis Pleocytosis Cerebrospinal fluid |
| title | Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 |
| title_full | Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 |
| title_fullStr | Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 |
| title_full_unstemmed | Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 |
| title_short | Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022 |
| title_sort | acute bacterial meningitis without cerebrospinal fluid pleocytosis in children results from a nationwide prospective surveillance system between 2001 and 2022 |
| topic | Acute bacterial meningitis Pleocytosis Cerebrospinal fluid |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224003278 |
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