Abstract

Objective: The initial clinical appearances of aseptic and bacterial meningitis in children are similar, but the treatment and outcome are quite different. To clarify the clinical presentation and laboratory results, we retrospectively reviewed our patients.

Methods: The charts of hospitalized children under age 18 with discharge diagnosis of aseptic meningitis and bacterial meningitis during 2007~2014 were reviewed. Patients with aseptic meningitis were recruited as pleocytosis and negative bacterial growth in cerebrospinal fluid (CSF), while those with bacterial meningitis were recruited only who had positive CSF bacterial culture results. Traumatic tapping, contaminated cultures, or having received previous intravenous antibiotic therapy were excluded. Viral pathogens in CSF of aseptic meningitis were identified by CSF culture or polymerase chain reaction.

Results: A total of 141 patients were enrolled as aseptic meningitis and 56 patients as bacterial meningitis. Aseptic meningitis occurred more in older than one-month-old children. Fever, headache, vomiting, and neck stiffness were significantly more in aseptic meningitis children, while convulsion, consciousness change, fontanelle bulging, and desaturation were significantly more in bacterial group. Significant laboratory differences were lymphocyte dominant in CSF, lower CSF protein level, higher CSF glucose level, and lower blood CRP level in aseptic meningitis group. Aseptic patients had shorter hospital duration (5.0 ± 2.0 days vs. 20.0 ± 8.0 days, p<0.001). All aseptic meningitis patients survived and were discharged without significant neurologic sequel. Among bacterial meningitis patients, 54.5% recovered completely, 10.9% died, and 34.5% had sequel. The outcome of aseptic meningitis group was significantly better than bacterial group.

Conclusion: Aseptic meningitis occurred more in toddLers and older children, and had more meningeal symptoms/signs. More than half bacterial meningitis occurred in neonates and revealed more dreadful systemic presentations. Laboratory results can be helpful for differentiation of aseptic meningitis from bacterial meningitis. Careful monitoring clinical conditions and laboratory results are mandatory.

Keywords: Bacterial meningitis; Aseptic meningitis; Cerebrospinal fluid; Symptoms/signs outcome; Infants; Children