Children Bacterial Meningitis Calculator

Helps with the differential diagnosis of bacterial & aseptic meningitis in pediatric patients.

In the text below the tool there is more information on the criteria used and about the original study.


The children bacterial meningitis calculator checks whether meningitis signs are present and if so, differentiated whether the cause is bacterial or aseptic.

This is based on blood absolute neutrophil count, CSF test, incidence or seizures and spinal fluid neutrophil count.


The result in points is interpreted as to whether bacterial meningitis is likely or not:

Result Interpretation
0 points Diagnosis of bacterial meningitis is unlikely but if suspicion persists, investigation into aseptic meningitis is recommended.
1 point Diagnosis of meningitis is likely but not enough evidence to distinguish between bacterial and aseptic.
2 – 6 points High likelihood of positive diagnosis for bacterial meningitis.

1

Blood absolute neutrophil count 10,000 cells/mm3 or more

2

Gram stain of CSF positive

3

CSF Protein more than 80 mg/dL

4

Incidence of seizures with illness

5

Spinal fluid neutrophil count ≥ 1000 cells/mm3

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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Criteria considered

The above model consists of five criteria that are analysed in the differential diagnosis of bacterial and aseptic meningitis:

Criteria Description
Blood absolute neutrophil count 10,000 cells/mm3 or more Increase in neutrophil granulocytes (PMNs) is sign of infectious disease.
Gram stain of CSF positive Primary culture helps identify possible infection cause, i.e. Neisseria.
CSF Protein more than 80 mg/dL Cerebrospinal fluid normal characteristics include a volume of up to 150 mL, osmolarity of 281 mOsm/L, pH between 7.28 and 7.32 and proteins between 15 – 40 mg/dL.
Incidence of seizures with illness Anticonvulsant therapy might be required to prevent seizures.
Spinal fluid neutrophil count ≥1000 cells per cubic mm Any increase in WBC from CSF is indicative of meningitis.

It is important to note that there is quite a high rate of false positives in gram stain of CSF because of contamination or misinterpretation.

High levels of protein in CSF indicate meningitis, brain abscesses, cerebral hemorrhage or neurosyphilis.

 

Result interpretation

When either of the criteria is present, a number of points is awarded. All criteria are awarded 1 point, except for “Gram stain of CSF” which is awarded 2 points.

After the points are summed, the result is interpreted in terms of likelihood of bacterial meningitis diagnosis:

Result Interpretation
0 points Diagnosis of bacterial meningitis is unlikely but if suspicion persists, investigation into aseptic meningitis is recommended.
1 point Diagnosis of meningitis is likely but not enough evidence to distinguish between bacterial and aseptic.
2 – 6 points High likelihood of positive diagnosis for bacterial meningitis.
 

About the study

Nigrovic et al. conducted a study in 2002 aimed at developing and validating a simple multivariable model to distinguish bacterial meningitis from aseptic meningitis in children. A cohort of 696 previously healthy children (aged from 29 days to 19 years) were included.

125 were diagnosed with bacterial meningitis and 571 with aseptic meningitis. A series of objective parameters available at the time of patient presentation were analysed through multivariable logistic regression and recursive partitioning.

This resulted in the creation of a bacterial meningitis scoring model which was in turn validated.

The negative predictive value of a score of 0 for bacterial meningitis was 100%. The sensitivity of scores of 2 or greater in predicting bacterial meningitis was 87%.

 

Bacterial meningitis guidelines

In BM, bacteria spreads through the blood stream and can reach the cerebrospinal fluid or can be localized there after severe infections such as otitis media or sinusitis or as a result of head trauma.

Comparing the two types of meningitis, aseptic or viral meningitis is more common and is easier to treat, plus has a lower risk of complications and of leaving sequels.

Complications following bacterial meningitis can lead to serious neurological impairment, hearing or visual loss.

When the meninges get inflamed, a triad of symptoms follow: fever, headache and neck stiffness.

Other symptoms from presentation include: photophobia, nausea, vomiting or sleepiness. In infants, this may be accompanied by bulging fontanelle, jaundice, paradoxic irritability and high pitched cry.

Meningitis diagnosis consists of laboratory tests:

■ Lumbar puncture;

■ Complete blood count;

■ Serum and CSF glucose levels;

■ Serum electrolytes;

■ Blood urea nitrogen.

Meningitis is more likely in children and young adults because these categories spend more time in close communities. This is why, routine vaccinations against meningococcal disease, such as MCV4, are recommended.

 

Original source

Nigrovic LE, Kuppermann 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(4):712-9.

Other references

1. Neuman MI, Tolford S, Harper MB. Test characteristics and interpretation of cerebrospinal fluid gram stain in children. Pediatr Infect Dis J. 2008; 27(4):309-13.

2. Mehl AL. Interpretation of traumatic lumbar puncture. A prospective experimental model. Clin Pediatr (Phila). 1986; 25(10):523-6.


App Version: 1.0.1

Coded By: MDApp

Specialty: Pediatrics

Objective: Diagnosis

Type: Calculator

No. Of Criteria: 5

Year Of Study: 2002

Article By: Denise Nedea

Published On: May 28, 2017 · 07:17 AM

Last Checked: May 28, 2017

Next Review: May 28, 2018