Appendix G



In children and young people with suspected meningitis, can CSF variables (white cell count, glucose, protein) distinguish between bacterial and viral meningitis?

Bibliographic information |Study type & evidence |Study details |Number of patients |Patient characteristics |Intervention & comparison |Follow up & outcome |Results & effect size |Reviewer comment | |Chavanet

2007 79

|Retro-spective cohort study

EL=III |Aim: to establish a scoring tool to distinguish bacterial and viral meningitis (BM & VM) and compare it to other available decision making tools |N=275

100 adults and 175 children with meningitis

BM=19,

VM=105

Undetermined meningitis (UM)=51

Data collected 1995-2002

|Children aged 3 months to 15 years hospitalised for acute meningitis between 1995 and 2002 at a French hospital |Infectious meningitis defined as more than 7 leucocytes/ml of CSF with no alternative diagnosis

Diagnosis of BM by identified bacterial pathogen in CSF (visually, culture) or blood (culture) or a significant concentration of bacterial antigen by latex agglutination was obtained in blood, urine or CSF, or seroconversion for Leptospiral spp. was evident.

Aseptic or viral meningitis diagnoses were given if a viral pathogen was identified in CSF, blood or stool or if no antibacterial treatments were administered.

Meningitis entered into the medical record as “either” category was classified as “undetermined” |Demo-graphic data, signs and symptoms data and CSF test results recorded from notes for CSF white cell count, CSF protein. |CSF White cell count

mean (SD) cells/ml BM=2994 (3263)

VM=218 (280)

UM=431 (772)

%CSF-PMN

BM= 87 (12)

VM=43(31)

UM=63(30)

Suggested threshold as part of Meningitest scoring =1800 cells/ml

(AROC analysis =0.75)

CSF neutrophil percentage >=80

AROC analysis 0.94)

CSF protein

mean (SD) g/l

BM=2.3 (1.5)

VM=0.38(0.18)

UM=0.47 (0.24)

Suggested threshold as part of Meningitest scoring = 1.2 g/l (AROC analysis =0.92)

|Country: France

Funding: Not reported

Note: this paper uses %CSF-PMN in tables and neutrophil percentage in the text and abstract – as far as I can tell they are using them to mean the same thing. | |Corrall 1981 80

|Prospective cohort study

EL=II

|Aim: to evaluate a CSF CRP latex agglutination system and compare its ability to discriminate between bacterial and non-bacterial meningitis with other CSF tests |N=56 children with meningitis

BM=24 (12/24 Hib)

VM=8

UM=24

VM + UM = nonbacterial meningitis

Data collection 1978-1980

|Children aged 1 month to 16 years with signs and symptoms of meningitis and more than 10WBC/mm3 in CSF were prospectively enrolled in the study between 1978 and 1980 in US |Diagnosis of bacterial meningitis by CSF culture and by bacterial antigen detection in CSF, serum and urine by counterimmunoelectrophoresis and immunoassay

Diagnosis of viral meningitis by CSF, serum, throat and rectal sample culture

|CSF test results prospectively recorded:

CSF white cell count

CSF protein

CSF glucose |CSF White cell count

mean (SD) cells/ mm3

BM=2417 (1380)

VM=149 (116)

UM=264 (204)

CSF PMN

mean (SD) cells/ mm3

BM=2171 (1382)

VM=60 (93)

UM=196 (184)

To differentiate between BM vs. VM+UM (@CSF WCC >500cells/mm3) sensitivity 74%, specificity 94%, PPV 89%, NPV 83%

To differentiate between BM vs. VM+UM (@CSF PMN concentration >200cells/mm3)

sensitivity 91%, specificity 84%, PPV 81%, NPV 93%

CSF protein

mean (SD) mg/dl

BM=174 (36)

VM=74 (35)

UM= 46 (11)

To differentiate between BM vs. VM+UM (at CSF [Protein] >100mg/dl)

sens 74%, spec 94%, PPV 89%, NPV 83%

CSF Glucose

mean (SD) mg/dl

BM=28 (8)

VM=56 (8)

UM=63 (6).

To differentiate between BM vs. VM+UM (@CSF [glucose] ................
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