A simple algorithm developed at the UC Davis Health System and Children's Hospital Boston can help doctors rapidly distinguish viral meningitis from bacterial meningitis in infants and children -- potentially reducing unnecessary hospital admissions and prolonged antibiotic treatment.
The finding, published in the Jan. 3 issue of the Journal of the American Medical Association, is based on the review of medical charts of thousands of children diagnosed with meningitis at 20 academic medical centers across the United States from January 2001 to June 2004.
"Viral or 'aseptic' meningitis beyond young infancy is usually a mild disease, while meningitis caused by bacteria can cause serious illness and death," said UC Davis Professor Nathan Kuppermann, a senior author on the study. He is chair of the Department of Emergency Medicine at the UC Davis Medical Center.
"Even though most patients will turn out to have viral meningitis, pediatric emergency department physicians usually hospitalize any child with meningitis to receive broad-spectrum antibiotics while waiting two to three days for the bacterial culture results."
Meningitis is an inflammation of the membranes surrounding the brain and spinal cord, and is usually first recognized by an abnormally high white blood cell count in the spinal fluid. While viral infections cause most meningitis cases, about one in 25 are caused by bacterial or fungal infections, which yield the most severe illness.
The new algorithm, called the Bacterial Meningitis Score, uses easily obtained results from routine tests of blood and fluid, including spinal fluid, Gram stain results, neutrophil count and protein concentration, as well as bloodstream neutrophil count. It also takes into account such factors as whether the child, during the illness at hand, has had a seizure.
-- UC Davis Health System