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Detecting Occult Meningitis with CSF WBC Count

doi: 10.1097/01.EEM.0000719116.75120.16
    Figure
    Figure:
    meningitis

    BY EMEDHOME.COM

    There is considerable overlap between cerebrospinal fluid (CSF) parameters in neonates with and without bacterial meningitis. (Clin Pediatr [Phila]. 2020;59[9-10]:893; Pediatrics. 2018;141[3]:e20173405; https://bit.ly/2CAc8oJ.)

    Neonatal meningitis, for example, can occasionally occur with normal CSF parameters. What level of CSF WBC count should suggest meningitis and prompt admission for IV antibiotics when working up a febrile neonate? The most recent clinical practice guidelines based on recent literature on febrile infants aged 0 to 56 days show that evidence of meningitis on the lumbar puncture for infants younger than 28 days is >18 WBCs and for those older than 28 days is >9 WBCs. (Clin Pediatr [Phila]. 2020;59[9-10]:893.)

    To be clear, this does not mean that CSF WBC counts below these thresholds exclude meningitis, but if performing an LP in a febrile infant aged 0 to 56 days to evaluate for meningitis, CSF WBC counts meeting these thresholds should be assumed to indicate meningitis until proven otherwise.

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