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Clinical decision rules for acute bacterial meningitis: current insights

Authors Viallon A, Bothelo-Nevers E, Zeni F

Received 15 September 2015

Accepted for publication 15 February 2016

Published 19 April 2016 Volume 2016:8 Pages 7—16


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Alain Viallon,1 Elisabeth Botelho-Nevers,2 Fabrice Zeni3

1Emergency Department, 2Department of Infectious Disease, 3Intensive Care Unit, University Hospital, Saint-Etienne, France

Abstract: Acute community-acquired bacterial meningitis (BM) requires rapid diagnosis so that suitable treatment can be instituted within 60 minutes of admitting the patient. The cornerstone of diagnostic examination is lumbar puncture, which enables microbiological analysis and determination of the cerebrospinal fluid (CSF) cytochemical characteristics. However, microbiological testing is not sufficiently sensitive to rule out this diagnosis. With regard to the analysis of standard CSF cytochemical characteristics (polymorphonuclear count, CSF glucose and protein concentration, and CSF:serum glucose), this is often misleading. Indeed, the relatively imprecise nature of the cutoff values for these BM diagnosis markers can make their interpretation difficult. However, there are two markers that appear to be more efficient than the standard ones: CSF lactate and serum procalcitonin levels. Scores and predictive models are also available; however, they only define a clinical probability, and in addition, their use calls for prior validation on the population in which they are used. In this article, we review current methods of BM diagnosis.

Keywords: meningitis, diagnosis, emergency

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