title: Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) cell count and biochemical examinations and cultures form the basis for the diagnosis of bacterial meningitis. However, some patients do not have typical findings and are at a higher risk of being missed or having delayed treatment. To better understand the correlation between CSF results and outcomes, we evaluated CSF data focusing on the patients with atypical findings.
  
  
  METHODS
  This study enrolled CSF culture-proven bacterial meningitis patients aged from 1 month to 18 years in a medical center. The patients were divided into "normal" and "abnormal" groups for each laboratory result and in combination. The correlations between the laboratory results and the outcomes were analyzed.
  
  
  RESULTS
  A total of 175 children with confirmed bacterial meningitis were enrolled. In CSF examinations, 16.2% of patients had normal white blood cell counts, 29.5% had normal glucose levels, 24.5% had normal protein levels, 10.2% had normal results in two items, and 8.6% had normal results in all three items. In logistic regression analysis, a normal CSF leukocyte count and increased CSF protein level were related to poor outcomes. Patients with meningitis caused by Streptococcus pneumoniae and hyponatremia were at a higher risk of mortality and the development of sequelae.
  
  
  CONCLUSIONS
  In children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Wen-Li
authors.initials: WL
authors.lastname: Lin
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Daniel Tsung-Ning
authors.initials: DT
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan. Electronic address: ncc88@mmh.org.tw.
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007958:Leukocyte Count; D007964:Leukocytosis / Q000134:cerebrospinal fluid*; D016920:Meningitis, Bacterial / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D011008:Pneumococcal Infections / Q000382:microbiology / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D013129:Spinal Puncture; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002556:Cerebrospinal Fluid Proteins
keywords: bacterial meningitis; cerebrospinal fluid; children; prognosis