ArticleBMC infectious diseases2006
Attenuated cerebrospinal fluid leukocyte count and sepsis in adults with pneumococcal meningitis: a prospective cohort study.
Article in BMC infectious diseases, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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15 citing papers in PubMed, 35 citations in OpenAlex.
- Neuroimmune Mechanisms Transforming Acute Injury to Long-Term Brain Dysfunction After Sepsis.Clinics in chest medicine · 2026Review
- Concomitant infectious foci in community-acquired bacterial meningitis: the clinical impact of concomitant spondylitis and endocarditis.BMC infectious diseases · 2025Article
- Granulocytes in cerebrospinal fluid of adults suspected of a central nervous system infection: a prospective study of diagnostic accuracy.Infection · 2024Article
- The Diagnostic Value of Cerebrospinal Fluid Lactate for Detection of Sepsis in Community-Acquired Bacterial Meningitis.Diagnostics (Basel, Switzerland) · 2023Article
- Recurrent Community-Acquired Bacterial Meningitis in Adults.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Community-acquired Bacterial Meningitis in Adults With Cerebrospinal Fluid Leakage.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Pneumococcal meningitis with normal cerebrospinal biochemistry and no pneumococci at microscopy, mimicking a stroke: a case report.Journal of medical case reports · 2017Article
- CNS infections in patients with hematological disorders (including allogeneic stem-cell transplantation)-Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO).Annals of oncology : official journal of the European Society for Medical Oncology · 2016Article
- Serotype and genotype distribution among invasive Streptococcus pneumoniae isolates in Colombia, 2005-2010.PloS one · 2014Article
- Cerebral infarction in adults with bacterial meningitis.Neurocritical care · 2012Article
- Validation of a Dutch risk score predicting poor outcome in adults with bacterial meningitis in Vietnam and Malawi.PloS one · 2012Article
- Complement component 5 contributes to poor disease outcome in humans and mice with pneumococcal meningitis.The Journal of clinical investigation · 2011Article
- Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis.Clinical microbiology reviews · 2010Review
- Cerebral infarction in bacterial meningitis: predictive factors and outcome.Journal of neurology · 2010Article
- Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998-2004).European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2007Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA low cerebrospinal fluid (CSF) white-blood cell count (WBC) has been identified as an independent risk factor for adverse outcome in adults with bacterial meningitis. Whereas a low CSF WBC indicates the presence of sepsis with early meningitis in patients with meningococcal infections, the relation between CSF WBC and outcome in patients with pneumococcal meningitis is not understood.
methodsWe examined the relation between CSF WBC, bacteraemia and sepsis in a prospective cohort study that included 352 episodes of pneumococcal meningitis, confirmed by CSF culture, occurring in patients aged >16 years.
resultsCSF WBC was recorded in 320 of 352 episodes (91%). Median CSF WBC was 2530 per mm3 (interquartile range 531-6983 per mm3) and 104 patients (33%) had a CSF WBC <1000/mm3. Patients with a CSF WBC <1000/mm3 were more likely to have an unfavourable outcome (defined as a Glasgow Outcome Scale score of 1-4) than those with a higher WBC (74 of 104 [71%] vs. 87 of 216 [43%]; P < 0.001). CSF WBC was significantly associated with blood WBC (Spearman's test 0.29), CSF protein level (0.20), thrombocyte count (0.21), erythrocyte sedimentation rate (-0.15), and C-reactive protein levels (-0.18). Patients with a CSF WBC <1000/mm3 more often had a positive blood culture (72 of 84 [86%] vs. 138 of 196 [70%]; P = 0.01) and more often developed systemic complications (cardiorespiratory failure, sepsis) than those with a higher WBC (53 of 104 [51%] vs. 69 of 216 [32%]; P = 0.001). In a multivariate analysis, advanced age (Odds ratio per 10-year increments 1.22, 95%CI 1.02-1.45), a positive blood culture (Odds ratio 2.46, 95%CI 1.17-5.14), and a low thrombocyte count on admission (Odds ratio per 100,000/mm3 increments 0.67, 95% CI 0.47-0.97) were associated with a CSF WBC <1000/mm3.
conclusionA low CSF WBC in adults with pneumococcal meningitis is related to the presence of signs of sepsis and systemic complications. Invasive pneumococcal infections should possibly be regarded as a continuum from meningitis to sepsis.
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