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You suspect meningitis in a 2 year old girl with fever, vomiting, irritability and a stiff neck. You perform a lumbar puncture. (Only one is correct)

Asked by Adsie, Last updated: Feb 08, 2024

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adsie

adsie

adsie
Adsie

Answered Oct 05, 2018

Febrile children without meningitis can have up to 48% neutrophils and a low glucose in their CSF

No bacteria on gram film are seen in up to 40% of bacterial meningitis even without prior antibiotics. Normal white cell counts and glucose in meningitis have been described but only where LP has been done within 12 hours of onset of symptoms. 57% of aseptic meningitis cases in 1 study had a neutrophil predominance. Acutely unwell children without meningitis can have white cell counts up to 16, with neutrophils up to 48%, and low glucose (seen in 25%) even without CNS infection. Correcting for blood staining does not improve diagnostic accuracy.
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