J Korean Child Neurol Soc.  2009 Nov;17(2):185-191.

The Useful Clinical Indicators of Performing a Spinal Tapping During an Outbreak of Enteroviral Meningitis

Affiliations
  • 1Department of Pediatrics, Chunchon Sacred Heart Hospital, Hallym University, Chunchon, Korea. pdneudoc@yahoo.co.kr

Abstract

PURPOSE
Although spinal tapping and cerebrospinal fluid analysis is essential for diagnosis of aseptic meningitis, it is equivocal that all patients with headache and vomiting should receive spinal tapping for diagnosis of meningitis during an outbreak of enteroviral meningitis in summer seasons. The purpose of this study was to find clinical indicators that may be useful for differentiation of bacterial meningitis, and also to compare the clinical course between spinal tapping group and non-spinal tapping group confirmed enteroviral infection.
METHODS
We retrospectively reviewed medical record of 65 cases of reverse transcription-polymerase chain reaction(RT-PCR) proven enteroviral meningitis, and 30 cases of culture proven bacterial meningitis admitted in Chunchon Sacred Heart Hospital. We compared the difference of clinical factors between bacterial and enteroviral meningitis groups and also clinical course between spinal tapping and non-spinal tapping groups.
RESULTS
Children with bacterial meningitis had younger age onset, high incidence of seizure and altered consciousness, increased C-reactive protein(CRP) levels(P<0.05), but no difference in fever degree at admission and white blood cell and platelet count, erythrocyte sedimentation rate(P>0.05). Children with spinal tapping group with enteroviral meningitis had longer hospital stay and duration of fever as compared to children in non-spinal tapping group(P<0.05), but no difference in duration of headache in both groups.
CONCLUSION
We recommend children with younger age, altered consciousness, having seizure and increased CRP levels receive spinal tapping for the differentiation of bacterial meningitis during an outbreak of enteroviral meningitis, and introduction of rapid diagnostic technique may reduce unnecessary spinal tapping, hospital stay and antibiotics therapy.

Keyword

Enteroviral meningitis; Spinal tapping; Clinical indicator

MeSH Terms

Anti-Bacterial Agents
Blood Sedimentation
Child
Consciousness
Fever
Headache
Heart
Humans
Incidence
Length of Stay
Leukocytes
Medical Records
Meningitis
Meningitis, Aseptic
Meningitis, Bacterial
Platelet Count
Retrospective Studies
Seasons
Seizures
Spinal Puncture
Vomiting
Anti-Bacterial Agents
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