[N.B.T.-test in diagnosis of paediatric bacterial meningitis (author's transl)]

Usefulness of N.B.T.-test (absolute values and percentages) has been tested in the diagnosis of "acute meningitis" in pediatric age. A total of 210 children of different ages have been divided in 3 groups: group A, consisting of 105 children with bacterial meningitis. Group B, 36 children with viral meningitis and group C formed by 69 health children. Differences between groups A and B were statistically significant (p less than 0.001) on both percentage and absolute values, while they were non-significant (p less than 0.001) on both percentage and absolute values, while they were non-significant between B and C groups. On serial controls of N.B.T. test percentage value during follow-up of the disease, a progressive normalization was observed which authors think had value for evaluation of the efficacy of the treatment as well as for prognostic significance. Results were tabulated on the normogram of Feign et al., with significant areas for each group.

Lumbar puncture in children with convulsions associated with fever

452 previously healthy children aged over six months and under six years were admitted to the Sheffield Children's Hospital between January, 1972, and December, 1976, after their first convulsion associated with fever. 304 of the children had a lumbar puncture. 25 punctures were necessary according to defined clinical criteria--including those in 15 children who were subsequently shown to have meningitis. All 148 children who did not have a lumbar puncture made a prompt and uneventful recovery. Children with convulsions associated with fever should be referred to hospital. A lumbar puncture should be performed when meningitis is suspected, after examination by a senior and experienced member of the staff. It should not be carried out as a routine procedure.

ECHO virus type 9 meningitis simulating tuberculous meningitis

An infant with mononuclear pleocytosis, hypoglycorrhachia, and elevated protein in cerebrospinal fluid emphasizes the occasional difficulty in distinguishing viral and tuberculous meningitis at the time of presentation. Although the cerebrospinal fluid values were compatible with tuberculous meningitis, ECHO virus type 9 was grown from the spinal fluid.

Evaluation of cerebrospinal fluid lactic acid levels as an aid in differential diagnosis of bacterial and viral meningitis in adults

The level of lactic acid in cerebrospinal fluid has been suggested as a useful diagnostic parameter to differentiate between bacterial and viral meningitis, especially in patients partially treated before admission to hospital. A concentration of greater than or equal to 35 mg/dl, determined by either gas-liquid chromatography or an enzymatic method, has been considered in several studies to provide definite evidence of meningitis of bacterial origin, whereas a lower level indicates no bacterial involvement. Over the past 18 months, we have analyzed by the enzymatic method the lactate level in 493 spinal fluids submitted from 434 adult patients with various conditions involving the central nervous system. Fifty fluids had a lactate level of greater than 35 mg/dl, of which 19 were cases of infective meningitis of varying etiology. The 435 specimens with lactate levels within the range considered normal included three cases of infective meningitis, of which two were cryptococcal and one was bacterial. In this adult study, the lactate level in the cerebrospinal fluid did not provide unequivocal evidence of bacterial infection and did not provide assistance to any greater degree than the standard parameters of leukocyte count, protein, and glucose contents in the differential diagnosis of bacterial meningitis from that of any other etiology.

Management of central nervous system infections during an epidemic of enteroviral aseptic meningitis

Four hundred and fifty-six patients with signs and symptoms of potential central nervous system infection were evaluated from June 28, 1978, to September 30, 1978. The majority of the children had a relatively brief and mild illness characterized by a constellation of features previously described with central nervous system infections. Fever, headache, and vomiting were typical. Altered sensorium and nuchal rigidity were inconstant. One distinct and another infrequently reported feature of enteroviral disease, hypoglycorrhachia and cerebrospinal fluid pleocytosis in excess of 2,000 cells/mm3, occurred independently or in concert in 18% of the cases. When these unexpected findings were associated with a presumptive clinical diagnosis of aseptic meningitis, watchful observation and repeat lumbar puncture precluded the necessity to administer antibiotics in every case. The possibility of enteroviral aseptic meningitis being a definitive diagnostic entity manageable on a group, yet individual basis utilizing a disposition protocol is discussed.

[Acute infections central nervous system. The significance of antiviral antibodies in the cerebrospinal fluid (author's transl)]

Examination of the CSF of 107 patients suffering from a viral infection of the central nervous system for the presence of antiviral antibodies indicated that 26 subjects (24 %) developed monospecific antibodies. The distribution of these antibodies differed according to whether the diagnosis was of meningitis or of encephalitis and myelitis since 3 patients out of 73 (4 %) with meningitis developed antibodies whilst the latter were detectable in 23 of the 34 subjects with encephalitis or myelitis (67 %). This difference was highly significant (p 0,001) and suggests that examination for antiviral antibodies in the CSF could be of use in the differential diagnosis between meningitis and encephalitis. Furthermore, the results presented suggest the existence of local production of antiviral antibodies in the CSF.

Pseudotetanus

Pseudotetanus is a syndrome which is produced by a variety of non-Clostridial factors. It is usually not difficult to distinguish from tetanus but is must always be considered in the differential diagnosis. Six cases are reported in which tetanus was considered and in one of them the full treatment for the disease was started. It is hoped that by increasing the awareness of clinicians of this relatively common problem the risk of making an incorrect disagnosis will be reduced.

Value of second lumbar puncture in confirming a diagnosis of aseptic meningitis. A prospective study

In patients with viral meningitis, polymorphonuclear leukocytes sometimes predominate in the CSF on initial examination. In a prospective analysis of this phenomenon, 16 consecutive patients with viral meningitis were followed up with serial CSF studies. The percentage of polymorphonuclear leukocytes showed a significant fall between initial and second examinations (41.75 +/- 27.0 to 8.6 +/- 8.78 [mean +/- 2 SD], P less than .001), while total WBC counts and the protein and sugar content levels remained unchanged. Based mainly upon this "polymorph shift," antibiotic therapy was correctly withheld from 100% of patients reexamined. On subsequent examinations, the percentage of polymorphonuclear cells remained low. All patients recovered completely without any specific treatment. In otherwise healthy subjects with the aseptic meningitis syndrome, antibiotic therapy can be withheld even when polymorphonuclear cells predominate on initial CSF examination. If suspicion arises regarding the diagnosis, another examination will demonstrate a significant fall in polymorphonuclear cells if the initial impression was correct.

Countercurrent immunoelectrophoresis in the diagnosis of viral infections of the central nervous system

Countercurrent immunoelectrophoresis was utilized in the study of 621 specimens of cerebrospinal fluid to determine the correlation of detection of viral antigens with the clinical diagnosis of aseptic meningitis and related viral infections. A panel of viral antisera was immunoelectrophoresed against 119 specimens from patients with suspected viral infections of the central nervous system (group I), 32 from patients with bacterial meningitis (group 2), and 470 from patients with no suspected infection of the nervous system (group 3). One or more precipitin bands were detected in 79% of specimens from group 1, 19% from group 2, and 4% from group 3. Paired acute- and convalescent-phase sera from 32 (78%) of 41 patients with precipitin bands detected by countercurrent immunoelectrophoresis demonstrated a fourfold or greater change in complement-fixing antibodies to the detected antigen. With refinements in antisera, countercurrent immunoelectrophoresis may become useful in the rapid laboratory diagnosis of viral infection of the central nervous system.