title: Differential diagnosis between viral and bacterial meningitis in children.
abstract: OBJECTIVE
  The differential diagnosis between viral meningitis and bacterial meningitis is often very difficult. The results of peripheral blood and spinal fluid analysis are not 100% accurate. We tried to find a useful 'bedside' decision-making tool, based on laboratory results readily available at the emergency department.
  
  
  METHODS
  Retrospective study design. Analysis of a consecutive series of all children (age 0-15 years) admitted to the paediatric ward because of a viral or bacterial meningitis, in the period from 1997 to September 2005.
  
  
  RESULTS
  Seventy-one children with viral and 21 with bacterial meningitis were included. Bacterial meningitis occurred at much younger ages than viral meningitis. The paediatrician decided to administer antibiotics in 41 of 71 children with viral meningitis and in all children with bacterial meningitis. We developed a 'bacterial meningitis score' based on C-reactive protein in peripheral blood, as well as glucose and protein in cerebrospinal fluid. Using this score, we could distinguish 54 of 71 patients with viral meningitis from the group with bacterial meningitis. When the dispensing of antibiotics was based on this score, only 16 patients with viral meningitis would receive antibiotics.
  
  
  CONCLUSIONS
  We present a bedside bacterial meningitis score. Using this bacterial meningitis score as a decision-making tool, we would be able to avoid antibiotics in a large number of children with viral meningitis. As this gives a 100% success rate, thus guaranteeing that bacterial meningitis patients would receive the proper therapy, our bacterial meningitis score could be an accurate decision-support tool.
authors.affiliation: Department of Neurology, Klina Regional Hospital, Brasschaat, Belgium. haralddecauwer@hotmail.com
authors.forename: Harald G
authors.initials: HG
authors.lastname: De Cauwer
authors.forename: Lieve
authors.initials: L
authors.lastname: Eykens
authors.forename: Johan
authors.initials: J
authors.lastname: Hellinckx
authors.forename: Luc J M
authors.initials: LJ
authors.lastname: Mortelmans
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001530:Belgium; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology*; D008587:Meningitis, Viral / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein