Abstract

PARTIALLY TREATED BACTERIAL MENINGITIS; THE DILEMMA CONTINUES

Groob Alkhayer, Maiass El Homsi and *Mhd Nezar Alsharif

Abstract

Objective: This study aimed to determine the effect of pretreatmentwith antibiotics before lumbar puncture on cerebrospinal fluidprofile(CSF) compared with the CSF results’ of patients who were notpretreated with antibiotics. Methods: This is a retrospective studycomposed of 55 children (newborns until 12 years old); who reviewedthe Children University Hospital Between 1/1/2015 and 20/11/2017and were diagnosed with acute bacterial meningitis. Results: A total of55 children were diagnosed with acute bacterial meningitis and wereincluded in this study. However only 23.6% (13 cases) of all patientsreceived antibiotics before cerebrospinal fluid analysis (CSF) and thosewere studied to determine the changes due to the pretreatment. Those patients (13 patients)CSF results’ revealed decreased WBC (white blood cell count) in 38.4% of them, lymphocytedominance in 61.5% of them, 62% of their culture results were sterile, high glucose levels in38.4% cases and low protein levels in (23% of them). Ceftriaxone was the most commonantibiotic given in this study and it caused significant differences in the CSF profile.Conclusion: We cannot dogmatize that prior treatment may cause a complete change in theCSF analysis results, and suggest a diagnosis of another form of meningitis based on the CSFprofile, but we are confident that the inappropriate pre-treatment will blur the diagnosis ofbacterial meningitis and make it harder to establish.

Keywords: Acute bacterial meningitis; antibiotic pretreatment; CSF analysis.