The DOI matches its Crossref record; 79 of the 79 references it cites were found in a registry or an index.
Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
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 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]
In the citing paper
“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]
Citations
Cites
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van de Beek, D., de Gans, J., Spanjaard, L., Weisfelt, M., Reitsma, J. B., & Vermeulen, M. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa040845 · Cited by 1,639
Acute Bacterial Meningitis in Adults -- A Review of 493 Episodes
Durand, M. L., Calderwood, S. B., Weber, D. J., Miller, S. I., Southwick, F. S., Caviness, V. S., & Swartz, M. N. (1993) · New England Journal of Medicine · doi:10.1056/nejm199301073280104 · Cited by 1,344
Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010) · Clinical Microbiology Reviews · doi:10.1128/cmr.00070-09 · Cited by 930
Self-citationCommunity-Acquired Bacterial Meningitis in Adults
van de Beek, D., de Gans, J., Tunkel, A. R., & Wijdicks, E. F. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmra052116 · Cited by 878
Self-citationCorless, C. E., Guiver, M., Borrow, R., Edwards-Jones, V., Fox, A. J., & Kaczmarski, E. B. (2001) · Journal of Clinical Microbiology · doi:10.1128/jcm.39.4.1553-1558.2001 · Cited by 598
Clinical recognition of meningococcal disease in children and adolescents
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Bacterial meningitis in children
Sáez‐Llorens, X., & McCracken, G. H. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13693-8 · Cited by 543
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Computed tomography of the head before lumbar puncture in adults with suspected meningitis
Hasbun, R., Abrahams, J., Jekel, J., & Quagliarello, V. J. (2001) · New England Journal of Medicine · doi:10.1056/nejmoa010399 · Cited by 462
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Tunkel, A. R., Hasbun, R., Bhimraj, A., Byers, K. E., Kaplan, S. L., Scheld, W. M., van de Beek, D., Bleck, T. P., Garton, H. J. L., & Zunt, J. R. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw861 · Cited by 1,125
Self-citationESCMID guideline: diagnosis and treatment of acute bacterial meningitis
van de Beek, D., Cabellos, C., Dzupova, O., Esposito, S., Klein, M., Kloek, A. T., Leib, S. L., Mourvillier, B., Ostergaard, C., Pagliano, P., et al. (2016) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2016.01.007 · Cited by 919
Self-citationCommunity-acquired bacterial meningitis
van de Beek, D., Brouwer, M. C., Hasbun, R., Koedel, U., Whitney, C. G., & Wijdicks, E. F. M. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.74 · Cited by 330
Self-citationCommunity-acquired bacterial meningitis.
van de Beek, D., Brouwer, M. C., Koedel, U., & Wall, E. C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00883-7 · Cited by 292
Self-citationAcute bacterial meningitis in adults
McGill, F., Heyderman, R. S., Panagiotou, S., Tunkel, A. R., & Solomon, T. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30654-7 · Cited by 274
Self-citation
Metadata
- 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)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-11
- Volume
- 380
- Issue
- 9854
- Pages
- 1684-1692
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- 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
- 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
- Health Sciences › Medicine › Microbiology (medical) › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Infectious Diseases › 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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