[en] The "Bacterial Meningitis Score" (BMS) has been designed to identify children at low (BMS = 0) or high (BMS > or = 2) risk of bacterial meningitis (M). Its calculation is simple; it is based on 5 different items: Gram stain, seizure at or before presentation, peripheral white blood cell count (WBC), cerebrospinal fluid (CSF) WBC and CSF protein concentration. As of today, it has been validated in one single study in the United States. The purpose of this study is to evaluate the BMS performance in children hospitalized for M over a 5 years period. The medical records of 277 patients diagnosed with M, aged 29 days to 15 years and hospitalized in the Department of Pediatrics of the CHR Citadelle Hospital in Liege between 1999 and 2003 were analysed. Among the 277 hospitalised cases, there were 29 bacterial (10,5%) and 248 viral (89,5%) M. For patients whose BMS < 2, we found 100% of viral M. For those with BMS > or = 2, 59,3% had a bacterial M and 40,7% had a viral M. 23% of the children with BMS < 2 were treated with antibiotics; 17% of children with BMS = 2 were not been treated on admission. The BMS is an easily applicable method that could allow reduce the unnecessary use of antibiotics.
Disciplines :
Pediatrics Immunology & infectious disease
Author, co-author :
PIERART, Julie ; Centre Hospitalier Universitaire de Liège - CHU > Pédiatrie
Lepage, P.
Language :
French
Title :
Utilite du "Bacterial Meningitis Score" (BMS) dans le diagnostic differentiel des meningites bacteriennes et virales
Alternative titles :
[en] Value of The "Bacterial Meningitis Score" (Bms) for the Differential Diagnosis of Bacterial Versus Viral Meningitis
Publication date :
July 2006
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
Bryant K, Marshall GS.- Most cerebrospinal fluid cultures in children with bacterial meningitis are positive within two days. Pediatr Infect Dis J, 1999, 18, 732-733.
Feigin RD, McCracken GH, Klein JO.- Diagnosis and management of meningitis. Pediatr Infect Dis J, 1992, 11, 785-814.
Radetsky M.- Duration of symptoms and outcome in bacterial meningitis: an analysis of causation and the implications of a delay in diagnosis. Pediatr Infect Dis J, 1992, 11, 694-698.
Oostenbrink R, Moons KG, Theunissen CC, et al.- Signs of meningeal irritation at the emergency department: how often bacterial meningitis? Pediatr Emerg Care, 2001, 17, 161-164.
Negrini B, Kelleher KJ, Wald ER.- Cerebrospinal fluid findings in aseptic versus viral meningitis. Pediatrics, 2000, 105, 316-319.
Bonadio WA.- The cerebrospinal fluid: physiologic aspect and alteration associated with bacterial meningitis. Pediatr Infect Dis J, 1992, 11, 423-432.
Bonadio WA.- Acute bacterial meningitis in older children. Am J Dis Child, 1990, 144, 463.
Viallon A, Pouzet F, Zeni F, et al.- Diagnostic rapide du type de méningite (bactérienne ou virale) par le dosage de la procalcitonine sérique. Press Med, 2000, 29, 584-588.
Spanos A, Harell F, Durack D.- Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observations. JAMA, 1989, 269, 2700-2707.
Glimaker M.- Enteroviral meningitis: diagnosis methods and aspects on the distinction from bacterial meningitis. Scand J Infect Dis, 1992, 85, 1-64.
Hansson LO, Axelsson G, Linne T, et al.- Serum C-reactive protein in the differential diagnosis of acute meningitis. Scand J Infect Dis, 1993, 25, 625-630.
Lembo RM, Marchant CD.- Acute phase reactants and risk of bacterial meningitis among febrile infants and children. Ann Emerg Med, 1991, 20, 36-40.
Cabeca HLS, Gomes HR, Machado LR, et al.- Dosage of lactate in the cerebrospinal fluid in infectious diseases of the central nervous system. Arq Neuropsiquiatr, 2001, 59, 843-848.
Marc E, Ménager C, Moulin F.- Procalcitonine et méningites virales: réduction des traitements antibiotiques inutiles par le dosage en routine au cours d'une épidémie. Arch Pédiatr, 2002, 9, 358-364.
Schwarz S, Bertram M, Schwab S, et al.- Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med, 2000, 28, 1828-1832.
Sène D, Bossi P, Zeller V, et al.- Méningite virale aiguë. Caractéristiques épidémiologiques, cliniques et biologiques de 29 patients hospitalisés. Presse Med, 2002, 31, 254-258.
Robinson CC, Willis M, Meagher A, et al.- Impact of rapid polymerase chain reaction results on management of pediatric patients with enteroviral meningitis. Pediatr Infect Dis J, 2002, 21, 283-286.
Nigrovic L E, Kupperman N, Malley R.- Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics, 2002, 110, 712-719.
Oostenbrink R, Moons KG, Twijnstra MJ, et al.- Children with méningeal signs. Ach Pediatr Adolesc Med, 2002, 156, 1189-1194.
Hoen B, Viel JF, Paquot C, et al.- Multivariate approach to differential diagnosis of acute meningitis. Eur J Clin Microbiol Inf Dis, 1995, 14, 267-274.
Deivanayagam N, Ashok TP, Nedunchelian K, et al.- Evaluation of CSF variables as a diagnostic test for bacterial meningitis. J Trop Pediatr, 1993, 39, 284-287.