Bacterial Meningitis - Lumbar Puncture - Procalcitonin | Digest

Pediatric Bacterial Meningitis: An Update on Early Identification and Management

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Points and Pearls Excerpt

  • Although the overall incidence of pediatric bacterial meningitis in the United States has decreased, the prevalence of non–PCV-13 pneumococcal serotypes and late-onset (6-90 days) and very-late-onset (> 90 days) group B Streptococcus meningitis has increased.
  • While the presence of the most widely recognized signs of bacterial meningitis—fever, bulging fontanel, meningismus, altered mental status, headache, and vomiting—significantly increases the likelihood of bacterial meningitis, a number of cases have been published in which these signs were absent.
  • Typically, patients with bacterial meningitis have an elevated CSF protein and a decreased CSF glucose-to-blood glucose ratio < 0.60.
  • The sensitivity of neck findings ranges from 45% to 95%. The sensitivity of assessing the range of motion in the sagittal plane may be enhanced by performing the test with the child sitting on the bed with legs outstretched rather than with the legs over the edge of the bed.

Most Important References

  • American Academy of Pediatrics. In: Kimberlin DW, Brady MT, Jackson MA, et al, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village: American Academy of Pediatrics; 2015. (Society recommendations and guidelines) content/red-book-30th-edition-2015
  • Milcent K, Faesch S, Gras-Le Guen C, et al. Use of procalcitonin assays to predict serious bacterial infection in young febrile infants. JAMA Pediatr. 2016;170(1):62-69. (Prospective cohort study; 2047 infants) DOI:
  • Guedj R, Chappuy H, Titomanlio L, et al. Do all children who present with a complex febrile seizure need a lumbar puncture? Ann Emerg Med. 2017;70(1):52-62 e56. (Retrospective study; 7 pediatric EDs, 839 patients with complex febrile seizure) DOI:
  • Thomson J, Cruz AT, Nigrovic LE, et al. Concomitant bacterial meningitis in infants with urinary tract infection. Pediatr Infect Dis J. 2017;36(9):908-910. (Retrospective study; 1737 infants) DOI:
  • Ogunlesi TA, Odigwe CC, Oladapo OT. Adjuvant corticosteroids for reducing death in neonatal bacterial meningitis. Cochrane Database Syst Rev. 2015(11):CD010435. (Cochrane review; 2 trials, 132 participants) DOI:
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Publication Information

Emerson Posadas, MD, MBA; Jay Fisher, MD, FAAP, FACEP

Peer Reviewed By

Sheldon L. Kaplan, MD; Lise Nigrovic, MD, MPH

Publication Date

November 2, 2018

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