Analysis of clinical outcomes in pediatric bacterial meningitis focusing on patients without cerebrospinal fluid pleocytosis

J Microbiol Immunol Infect. 2016 Oct;49(5):723-728. doi: 10.1016/j.jmii.2014.08.013. Epub 2014 Nov 1.


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.

Keywords: bacterial meningitis; cerebrospinal fluid; children; prognosis.

MeSH terms

  • Adolescent
  • Blood Glucose / analysis
  • Cerebrospinal Fluid Proteins / analysis
  • Child
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Leukocyte Count
  • Leukocytosis / cerebrospinal fluid*
  • Meningitis, Bacterial / microbiology
  • Meningitis, Bacterial / mortality*
  • Meningitis, Bacterial / therapy*
  • Pneumococcal Infections / microbiology
  • Pneumococcal Infections / mortality*
  • Pneumococcal Infections / therapy*
  • Retrospective Studies
  • Spinal Puncture
  • Streptococcus pneumoniae / isolation & purification*
  • Treatment Outcome


  • Blood Glucose
  • Cerebrospinal Fluid Proteins