Clinical Presentations and the Bacterial Meningitis Score in Children with Cerebrospinal Fluid (CSF) Pleocytosis

Abstract

PURPOSE: The differential diagnosis between aseptic meningitis and bacterial meningitis in children is often very difficult. The current study was performed to investigate the clinical presentations, cerebrospinal fluid (CSF) and the Bacterial Meningitis Score (BMS) in children presenting with CSF pleocytosis (> or =10 WBC/mm3). METHODS: We retrospectively analyzed medical records of children (age three months-15 years) with CSF pleocytosis between January 2012 to January 2013 at Gangnam Severance Hospital. RESULTS: The dominant clinical symptoms were fever (92.5%), headache (87.5%), and vomiting (75%). Neck stiffness was noted in 20% of the patients. Three patients who were younger than three years old could not properly present meningeal signs. The majority (36 patients, 90%) were hospitalized, with a median stay of three days. There was no one who had bacterial meningitis. The BMS was calculated for all patients. Among them, 27 patients (67.5%) showed a BMS of 0 which represents very low risk for bacterial meningitis and the remaining 13 patients (32.5%) showed a BMS of 1. CONCLUSION: The BMS may be helpful to guide clinical decision making for the management of children with CSF pleocytosis. Additional multicenter studies in Korea are now needed to evaluate whether the BMS can be used to safely reduce hospital admission and antibiotic use for children with aseptic meningitis.