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A 2-year-old girl presented with 1-day history of temperature, off food and “not herself”. Clinical examination showed a slightly irritable child with a temperature of 38.8°C, mildly congested throat and doubtful neck stiffness, with no other apparent focus of infection. Urine was clear. A full septic screen was performed including lumbar puncture. C reactive protein was 38; cerebrospinal fluid (CSF) showed glucose 3.6 mmol (blood glucose 4.8 mmol), protein 0.6 g/l, white blood cell count 4 with no bacteria on Gram staining. The child was observed with a diagnosis of viral illness without any antibiotics. We wondered: can meningitis occur with initial normal CSF?
Structured clinical question
In a child with suspected meningitis (subject), the initial CSF findings normal (intervention), is that reassuring enough to exclude bacterial meningitis (outcome)?
This review was aimed to obtain all available information with the intention of providing a perspective for resolving this issue. A non-systematic search of the world literature was carried out using English as the main language in July 2008 using the Cochrane Library, PubMed, Medline (1950 to date), Embase (1974 to date), and Cinhal (1982 to date) via the NHS healthcare database. The following …