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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Vydáno v:	The Lancet (British edition) Ročník 380; číslo 9854; s. 1684 - 1692
Hlavní autoři:	Brouwer, Matthijs C, Thwaites, Guy E, Tunkel, Allan R, van de Beek, Diederik
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Kidlington Elsevier Ltd 10.11.2012 Elsevier Elsevier Limited
Témata:	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
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Shrnutí:	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.
Bibliografie:	http://dx.doi.org/10.1016/S0140-6736(12)61185-4 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 content type line 14 ObjectType-Feature-3 ObjectType-Article-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23 ObjectType-Feature-1
ISSN:	0140-6736 1474-547X 1474-547X
DOI:	10.1016/S0140-6736(12)61185-4