Acute bacterial meningitis without cerebrospinal fluid pleocytosis in children: results from a nationwide prospective surveillance system between 2001 and 2022

IF 4.8 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Infectious Diseases Pub Date : 2024-10-05 DOI:10.1016/j.ijid.2024.107256

Lama Jaber , Corinne Levy , Naïm Ouldali , Emmanuelle Varon , Muhamed-Kheir Taha , Stéphane Bonacorsi , Stéphane Béchet , François Angoulvant , Robert Cohen , Alexis Rybak , French Pediatric Meningitis Network

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引用次数: 0

Abstract

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.

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无脑脊液多细胞症的儿童急性细菌性脑膜炎：2001 年至 2022 年全国前瞻性监测系统的结果。

目的我们旨在描述无脑脊液（CSF）多形细胞增多的急性细菌性脑膜炎（ABM）病例以及患儿的临床和生物学特征：我们分析了法国全国范围内对 3 个月至 15 岁儿童急性细菌性脑膜炎的前瞻性监测研究结果。脑脊液白细胞计数≤5/mm即为无脑脊液白细胞增多：2001年至2022年期间的4,754例急性ABM病例中，有173例患者（3.6%）没有出现脑脊液白细胞增多。无 CSF 多形性脑膜炎球菌病例主要与脑膜炎球菌有关（70% 与 44% 有 CSF 多形性脑膜炎球菌病例相比，p 结论：无 CSF 多形性脑膜炎球菌病例主要与脑膜炎球菌有关：无 CSF 多形核细胞增多的 ABM 并非罕见，尤其是在入院前有癫痫发作的儿童中。广泛接种脑膜炎球菌疫苗可以预防这种临床形式的高致死率病例。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Infectious Diseases 医学-传染病学

CiteScore

18.90

自引率

2.40%

发文量

1020

审稿时长

30 days

期刊介绍： International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.