Dilemmas in the diagnosis of acute community-acquired bacterial meningitis

Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are commo...

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Veröffentlicht in:The Lancet (British edition) Jg. 380; H. 9854; S. 1684 - 1692
Hauptverfasser: Brouwer, Matthijs C, Thwaites, Guy E, Tunkel, Allan R, van de Beek, Diederik
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Kidlington Elsevier Ltd 10.11.2012
Elsevier
Elsevier Limited
Schlagworte:
Acute Disease
Age
Anti-Bacterial Agents - therapeutic use
Antibiotics
Autoimmune diseases
Bacteria
Bacterial diseases
Bacterial diseases of the nervous system. Bacterial myositis
Biological and medical sciences
Biomarkers - blood
Biomarkers - cerebrospinal fluid
brain
cerebrospinal fluid
clinical examination
Community-Acquired Infections - cerebrospinal fluid
Community-Acquired Infections - diagnosis
Community-Acquired Infections - drug therapy
complications (disease)
Decision Support Techniques
Diagnosis, Differential
Disease
Family medical history
Fever
General aspects
Headaches
HIV
Human bacterial diseases
Human immunodeficiency virus
Humans
image analysis
Immune status
Infectious diseases
Internal Medicine
Medical History Taking - methods
Medical sciences
Meningitis
Meningitis, Bacterial - cerebrospinal fluid
Meningitis, Bacterial - diagnosis
Meningitis, Bacterial - drug therapy
Microbiology
mortality
patients
Physical Examination - methods
Physicians
prediction
Prediction models
Spinal Puncture - methods
Streptococcus infections
Tomography, X-Ray Computed
Infection
Medicine
Nervous system diseases
Community acquired infection
Bacterial meningitis
Acute
Bacteriosis
Diagnosis
ISSN:0140-6736, 1474-547X, 1474-547X
Online-Zugang:Volltext
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Abstract Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
AbstractList Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
Summary Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.
Author Tunkel, Allan R
Thwaites, Guy E
Brouwer, Matthijs C
van de Beek, Diederik
Author_xml – sequence: 1
  givenname: Matthijs C
  surname: Brouwer
  fullname: Brouwer, Matthijs C
  organization: Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
– sequence: 2
  givenname: Guy E
  surname: Thwaites
  fullname: Thwaites, Guy E
  organization: Department of Infectious Diseases/Centre for Clinical Infection and Diagnostics Research, Kings College London, London, UK
– sequence: 3
  givenname: Allan R
  surname: Tunkel
  fullname: Tunkel, Allan R
  organization: Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA
– sequence: 4
  givenname: Diederik
  surname: van de Beek
  fullname: van de Beek, Diederik
  email: d.vandebeek@amc.uva.nl
  organization: Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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https://www.ncbi.nlm.nih.gov/pubmed/23141617$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright 2012 Elsevier Ltd
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Issue 9854
Keywords Infection
Medicine
Nervous system diseases
Community acquired infection
Bacterial meningitis
Acute
Bacteriosis
Diagnosis
Language English
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CC BY 4.0
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23141602 - Lancet. 2012 Nov 10;380(9854):1623-4
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– reference: 23141602 - Lancet. 2012 Nov 10;380(9854):1623-4
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Snippet Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical...
Summary Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by...
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SubjectTerms Acute Disease
Age
Anti-Bacterial Agents - therapeutic use
Antibiotics
Autoimmune diseases
Bacteria
Bacterial diseases
Bacterial diseases of the nervous system. Bacterial myositis
Biological and medical sciences
Biomarkers - blood
Biomarkers - cerebrospinal fluid
brain
cerebrospinal fluid
clinical examination
Community-Acquired Infections - cerebrospinal fluid
Community-Acquired Infections - diagnosis
Community-Acquired Infections - drug therapy
complications (disease)
Decision Support Techniques
Diagnosis, Differential
Disease
Family medical history
Fever
General aspects
Headaches
HIV
Human bacterial diseases
Human immunodeficiency virus
Humans
image analysis
Immune status
Infectious diseases
Internal Medicine
Medical History Taking - methods
Medical sciences
Meningitis
Meningitis, Bacterial - cerebrospinal fluid
Meningitis, Bacterial - diagnosis
Meningitis, Bacterial - drug therapy
Microbiology
mortality
patients
Physical Examination - methods
Physicians
prediction
Prediction models
Spinal Puncture - methods
Streptococcus infections
Tomography, X-Ray Computed
Title Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
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