J Korean Child Neurol Soc.  2017 Mar;25(1):39-43. 10.0000/jkcns.2017.25.1.39.

The Application of Bacterial Meningitis Score for Bacterial Meningitis and Enteroviral Meningitis in Pediatric Patients

• Park M
• kim S
• Yeom JS
• Park JS
• Park ES
• Seo JH
• Lim JY
• Woo HO
• Youn HS

• KMID: 2385212
• DOI: http://doi.org/10.0000/jkcns.2017.25.1.39

Abstract

PURPOSE
Bacterial meningitis score (BMS) has been introduced as a clinical predictive parameter for diagnosing cerebrospinal fluid (CSF) pleocytosis in children at very low risk of bacterial meningitis in the postconjugate vaccine era. This study aimed to examine the usefulness of the BMS and to identify an additional index to distinguish between enteroviral meningitis and bacterial meningitis.
METHODS
We retrospectively included 289 patients with enteroviral meningitis and 10 patients with bacterial meningitis between the aged 2 months to 16 years. We applied the BMS to all the included patients, and compared the initial laboratory and clinical characteristics between the two groups.
RESULTS
Of the 210 patients categorized as having a very low risk of bacterial meningitis based on BMS, 2 (1%) had bacterial meningitis, both of whom were younger than 3 months. The sensitivity, specificity, and negative predictive value of the BMS for bacterial meningitis were 80%, 72%, and 99%, respectively. Compared with patients with enteroviral meningitis, those with bacterial meningitis were younger (0.3 years vs. 5.0 years, P<0.01), had higher leukocyte count (530/mm³ vs. 43/mm³, P=0.04), neutrophil count (490/mm³ vs. 20/mm³, P<0.01), and protein level (106 mg/dL vs. 30 mg/dL, P<0.01) in the CSF, and increased serum C-reactive protein (CRP) level (79 mg/L vs. 4.5 mg/L, P<0.01).
CONCLUSION
Although the BMS is a useful clinical predictive parameter for identifying children with CSF pleocytosis who are at very low risk of bacterial meningitis, it should be applied with caution in young infants. In addition to applying BMS, clinical parameters such as CSF profiles and serum CRP levels are useful in clinical decision making for the management of children with CSF pleocytosis.

Keyword

Bacterial meningitis; Aseptic meningitis; Bacterial meningitis score

MeSH Terms

C-Reactive Protein
Cerebrospinal Fluid
Child
Clinical Decision-Making
Humans
Infant
Leukocyte Count
Leukocytosis
Meningitis*
Meningitis, Aseptic
Meningitis, Bacterial*
Neutrophils
Retrospective Studies
Sensitivity and Specificity
C-Reactive Protein