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 hyponatremiawere at a higher risk ofmortality 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.
Copyright ª 2014, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights
reserved.