Adults with suspected central nervous system infection: a prospective study of diagnostic accuracy
Open accessAbstract
Objectives To study the diagnostic accuracy of clinical and laboratory features in the diagnosis of central nervous system (CNS) infection and bacterial meningitis.Methods We included consecutive adult episodes with suspected CNS infection who underwent cerebrospinal fluid (CSF) examination. The reference standard was the diagnosis classified into five categories: 1) CNS infection; 2) CNS inflammation without infection; 3) other neurological disorder; 4) non-neurological infection; and 5) other systemic disorder.Results Between 2012 and 2015, 363 episodes of suspected CNS infection were included. CSF examination showed leucocyte count >5/mm 3 in 47% of episodes. Overall, 89 of 363 episodes were categorized as CNS infection (25%; most commonly viral meningitis [7%], bacterial meningitis [7%], and viral encephalitis [4%]), 36 (10%) episodes as CNS inflammatory disorder, 111 (31%) as systemic infection, in 119 (33%) as other neurological disorder, and 8 (2%) as other systemic disorders. Diagnostic accuracy of individual clinical characteristics and blood tests for the diagnosis of CNS infection or bacterial meningitis was low. CSF leucocytosis differentiated best between bacterial meningitis and other diagnoses (area under the curve [AUC] 0.95) or any neurological infection versus other diagnoses (AUC 0.93).Conclusions Clinical characteristics fail to differentiate between neurological infections and other diagnoses, and CSF analysis is the main contributor to the final diagnosis.
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Presenting features of ABM in adults vary according to patient age and cannot reliably distinguish bacterial from viral meningitis or other differential diagnoses.
“Presenting features of ABM in adults vary according to patient age 28 and cannot reliably distinguish bacterial from viral meningitis or other differential diagnoses.29”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [29]
Numerous adjunctive interventions have shown promise in tissue culture and animal models.
“Numerous adjunctive interventions have shown promise in tissue culture and animal models.29”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [29]
The Introduction describes a study of diagnostic accuracy in adults with suspected CNS infection, while the Results report clinical investigations and treatments. Searches for adjunctive interventions and for experimental animal or tissue-culture models found no passage addressing whether such interventions showed promise. (LLM, conf=0.76)
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“However, a study on diagnostic accuracy in suspected CNS infections showed that most clinical characteris tics and laboratory features cannot reliably rule out a CNS infection (319).”
Self-citationBacterial meningitis presenting with a normal cerebrospinal fluid leukocyte count
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- Authors
- Khatib, U., van de Beek, D., Lees, J. A., & Brouwer, M. C.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Wellcome Sanger Institute (GB)
- Corresponding author
- Brouwer, Matthijs C.
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 74
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0163-4453 (ISSN-L)
- PMC
- PMC7612037
- OpenAlex
- W2530947288
- Cited by
- 97
- References
- 9
- Citations by year
- 2026: 7 · 2025: 11 · 2024: 12 · 2023: 6 · 2022: 10 · 2021: 12 · 2020: 5 · 2019: 18 · 2018: 8 · 2017: 8
- FWCI
- 11.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Infection (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- PubMed Central (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Netherlands Organization for Health Research and Development (916.13.078, 016.116.358)
- European Research Council (281156)
- Medical Research council (1365620)
- Wellcome Trust (098051)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
- Keywords
- central nervous system infection, bacterial meningitis, diagnostic accuracy, cerebrospinal fluid analysis, viral meningitis, viral encephalitis, clinical features, adults
- MeSH terms
- Adult, Aged, Central Nervous System Infections, Encephalitis, Female, Humans, Male, Middle Aged, Prospective Studies, Meningitis, Bacterial, Clinical Laboratory Techniques
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