Clinical, anamnestic and laboratory features in children with early stages of meningitis

This article presents the results of a study aimed at identifying the clinical, anamnestic, and laboratory features of bacterial and viral meningitis in children on the first disease days. Materials and Methods: This prospective study included 37 children with etiologically confirmed meningitis (bacterial purulent (n = 20) and viral (n = 17) and 26 children with meningism. Following standardized protocols, the medical histories data, results of physical examination, and laboratory tests (blood and CSF) were obtained. ROC curve analysis was performed, and a predictive model was constructed using binary logistic regression. Results: The duration of general cerebral symptoms as the first signs of meningitis syndrome was: in group №1 — 1.0 [1.0—2.0], №2 — 1.0 [1.0—3.0], №3 — 2.0 [1.0—4.0] days (p = 0.309). Altered level of consciousness increased the odds (odds ratio) of bacterial etiology by 17.5 times (95% CI 3.016—101.54). The following symptoms were sensitive for the meningitis in the first days: neck stiffness (Se = 89.2%; Sp = 38.5%), the «seating» symptom (Se = 77.8%; Sp = 44.0%). There were no significant differences in meningeal symptoms in the early stages of the disease between viral and bacterial meningitis. Laboratory tests of bacterial meningitis in our study were characterized by high C-reactive protein levels and neutrophilic leukocytosis with lymphopenia. In the first days of general cerebral symptoms of bacterial meningitis, elevated CSF lactate concentrations (> 3.45 mmol/L) (Se = 80%, Sp = 100%) are typical. Conclusions: The clinical presentation of acute meningitis in the early stages exhibits typical symptoms of varying severity. However, physical examination alone does not allow for a clear differentiation of the etiology, necessitating the search for sensitive and specific laboratory markers for differential diagnosis.

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