Journal Logo

EMedHome's Clinical Pearl

EMedHome's Clinical Pearl

Detecting Occult Meningitis with CSF WBC Count

doi: 10.1097/01.EEM.0000719116.75120.16


    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;

    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.

    This Clinical Pearl first appeared on Subscribers receive a new clinical pearl emailed to them every Wednesday. on

    Visit our website for videos and podcasts from Amal Mattu, MD, and other noted emergency physicians from and EMedHome's video lectures at

    This Month's Video

    Ilene Claudius, MD: Infantile Spasms: Dr. Claudius is an associate clinical professor of emergency medicine at Harbor-UCLA Medical Center.

    This Month's Podcast

    Amal Mattu, MD, and Colleagues: Homeostasis, Headache, and Neurosyphillis: Dr. Mattu is one of the premier speakers in emergency medicine, and a professor of emergency medicine and the vice chair of emergency medicine at the University of Maryland School of Medicine in Baltimore.

    Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.