Dilemmas in the diagnosis of acute community-acquired bacterial meningitis

Brouwer, Matthijs C; Thwaites, Guy E; Tunkel, Allan R; van de Beek, Diederik

doi:10.1016/s0140-6736(12)61185-4

Cited by 304Bacterial Infections and VaccinesBacterial Identification and Susceptibility TestingInfectious Diseases and Tuberculosis

Dilemmas in the diagnosis of acute community-acquired bacterial meningitis

Brouwer, Matthijs C, Thwaites, Guy E, Tunkel, Allan R, van de Beek, Diederik·2012·The Lancet

DOI 10.1016/s0140-6736(12)61185-4

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Abstract

Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. Results of cerebrospinal fluid (CSF) examination should be interpreted carefully, because CSF abnormalities vary according to the cause, patient's age and immune status, and previous treatment. Diagnostic prediction models that use a combination of clinical findings, with or without test results, can help to distinguish acute bacterial meningitis from other causes, but these models are not infallible. We review the dilemmas in the diagnosis of acute community-acquired bacterial meningitis, and focus on the roles of clinical assessment and CSF examination.

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Clinical presentation can vary significantly from one patient to another, can be difficult to assess objectively, and may even be absent in some cases.
“Clinical data, such as headaches, photophobia, phonophobia, fever, or neck stiffness, were not collected for several reasons: (i) the clinical presentation can vary significantly from one patient to another, can be difficult to assess objectively, and may even be absent in some cases (19), (ii)”
From Optimized use of the FilmArray Meningitis/Encephalitis panel for early discontinuation of antibiotic therapy (2026) · cites this paper as [19]
Kernig's and Brudzinski's signs are often cited but their sensitivity can be as low as 5%.
“Kernig's and Brudzinski's signs are often cited but their sensitivity can be as low as 5%.33”
From Community-acquired acute bacterial meningitis in adults: a clinical update (2019) · cites this paper as [33]

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Authors: Brouwer, M. C., Thwaites, G. E., Tunkel, A. R., & van de Beek, D.
Affiliations: Amsterdam UMC Location University of Amsterdam (NL)
King's College London (GB)
Monmouth Medical Center (US)
ORCID: Brouwer, Matthijs C
Thwaites, Guy E
Tunkel, Allan R
Venue: The Lancet
Publisher: Elsevier BV
Published: 2012-11
Volume: 380
Issue: 9854
Pages: 1684-1692
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(12)61185-4
OpenAlex: W2131707675
Cited by: 302
References: 78
Citations by year: 2026: 19 · 2025: 21 · 2024: 27 · 2023: 22 · 2022: 23 · 2021: 18 · 2020: 20 · 2019: 21 · 2018: 22 · 2017: 18 · 2016: 34 · 2015: 24 · 2014: 20 · 2013: 12 · 2012: 1
FWCI: 2.62
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Research Portal (King's College London) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Topics: Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
Keywords: community-acquired bacterial meningitis, cerebrospinal fluid analysis, diagnostic prediction model, atypical presentation, clinical evaluation, neuroimaging, diagnostic sensitivity
MeSH terms: Acute Disease, Anti-Bacterial Agents, Decision Support Techniques, Diagnosis, Differential, Humans, Medical History Taking, Physical Examination, Spinal Puncture, Tomography, X-Ray Computed, Biomarkers, Meningitis, Bacterial, Community-Acquired Infections

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Dilemmas in the diagnosis of acute community-acquired bacterial meningitis

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