Distinguishing cerebrospinal fluid abnormalities in children with bacterial meningitis and traumatic lumbar puncture

Article Abstract:

Lumbar puncture is a procedure that is used to obtain samples of cerebrospinal fluid (CSF) for clinical diagnosis. If the puncture involves severe tissue trauma or damage, blood cells from damaged blood vessels can appear in the CSF sample. This can result in an inaccurate determination of the presence of blood cells in the CSF. This is especially important to be aware of in cases of pleocytosis, a condition involving an increased number of white blood cells in the CSF, as traumatic lumbar puncture may interfere with an accurate diagnosis. The effect of traumatic lumbar puncture on CSF samples obtained from children, with and without bacterial meningitis, was evaluated. The study involved 92 children, 30 with and 62 without bacterial meningitis. Ninety-three percent of the patients with bacterial meningitis had 10 times the normal level of white blood cells in their CSF. In contrast, only 3 percent of the patients without bacterial meningitis had CSF white blood cell counts that were 10 times higher than normal. Polymorphonuclear leukocytes (PMN) were the main type of white blood cell found in the CSF. PMN were found in 97 percent and 11 percent of the patients with and without bacterial meningitis, respectively. Hypoglycorrhachia (abnormally low levels of sugar in the CSF) is common in bacterial meningitis. CSF samples showed signs of hypoglycorrhachia in 73 percent and 3 percent of the patients with and without bacterial meningitis, respectively. It is concluded that traumatic lumbar puncture does not obscure clinical diagnosis of CSF samples in patients with bacterial meningitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Diagnosis, Meningitis, Spine, Lumbar puncture, Cerebrospinal fluid

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Escherichia coli bacteremia in children: a review of 91 cases in 10 years

Article Abstract:

Escherichia coli (E coli), a type of bacteria usually found in the intestine, can cause serious infections when present in other areas of the body. Up to 60 percent of children with systemic E. coli infections may die. The course of sepsis (systemic infection) caused by E. coli has been poorly described in children. The cases of 91 children infected with this bacteria were reviewed; two-thirds of the patients were under one year old. Fever occurred in 58 children, and 13 had low blood pressure at rates lower than previously reported. Most patients aged 10 or older had an immune deficiency condition, such as that associated with cancer chemotherapy. Infants under one month tended not to have fevers, but frequently developed low blood pressure. Almost one-third of infections were acquired in the hospital. Ninety percent of cases were associated with underlying conditions such as immune deficiency, urinary tract infection, or lesions of the digestive tract. Among children being treated for cancer the death rate was 29 percent, a rate lower than seen with other similar infections. Children without fever tended to have a poorer prognosis, possibly indicating inadequate host response to bacterial infection. The overall mortality was 12 percent, and death was associated with low blood pressure requiring treatment, low white blood cell levels, and patients who required a catheter in the vena cava (principal vein in the body, draining into the heart). (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Escherichia coli infections

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Klebsiella pneumoniae bacteremia in children: fifty-seven cases in 10 years

Article Abstract:

Klebsiella pneumoniae bacteria infections, most often found in the respiratory tract, stomach and intestines, rarely occur in the blood of children. The characteristics of klebsiella bacteremia infections in children were reviewed from 57 cases reported over a 10-year period in one hospital. Of the 5,156 blood cultures analyzed, 1.1 percent indicated klebsiella pneumoniae. Two thirds of the cases were found among children under the age of 12 months. Fever was present at diagnosis in eight children. There were no other factors distinguishing klebsiella infections from other causes of bacteremia. Almost all cases (93 percent) were associated with an underlying disease or condition. Of the children with bacteremia, 56 percent had diseases affecting the stomach and intestines, 35 percent had an indwelling catheter (a tube inserted to deliver chemotherapy), and 25 percent had a reduction in neutrophils (white blood cells involved in fighting infections). Twenty-five percent of the patients were receiving intravenous antibiotic therapy at the time bacteremia was diagnosed. The mortality from klebsiella bacteremia in this study was 20 percent. Klebsiella pneumoniae bacteremia is a rare but potentially life-threatening condition in children particularly those with an underlying disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Infection, Causes of, Pediatric diseases, Blood, Bacteremia, Klebsiella, Septicemia, Infection in children

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