Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Chiba, Japan.
Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan.
Can J Infect Dis Med Microbiol. 2014 Sep;25(5):249-51. doi: 10.1155/2014/568169.
Elevation of cerebrospinal fluid (CSF) cell count is a key sign in the diagnosis of bacterial meningitis. However, there have been reports of bacterial meningitis with no abnormalities in initial CSF testing. This type of presentation is extremely rare in adult patients. Here, a case involving an 83-year-old woman who was later diagnosed with bacterial meningitis caused by Neisseria meningitidis is described, in whom CSF at initial and second lumbar puncture did not show elevation of cell counts. Twenty-six non-neutropenic adult cases of bacterial meningitis in the absence of CSF pleocytosis were reviewed. The frequent causative organisms were Streptococcus pneumoniae and N meningitidis. Nineteen cases had bacteremia and seven died. The authors conclude that normal CSF at lumbar puncture at an early stage cannot rule out bacterial meningitis. Therefore, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately if there are any signs of sepsis or meningitis.
脑脊液（CSF）细胞计数升高是细菌性脑膜炎诊断的关键标志。然而，有报道称初始 CSF 检测无异常的细菌性脑膜炎。这种表现形式在成年患者中极为罕见。本文报道了一例 83 岁女性患者，后被诊断为脑膜炎奈瑟菌引起的细菌性脑膜炎，其初始和第二次腰椎穿刺的 CSF 细胞计数均未升高。对 26 例非中性粒细胞减少性成人细菌性脑膜炎中无 CSF 细胞增多症的病例进行了回顾性分析。常见的病原体为肺炎链球菌和脑膜炎奈瑟菌。19 例有菌血症，7 例死亡。作者得出结论，早期腰椎穿刺时正常的 CSF 并不能排除细菌性脑膜炎。因此，如果有败血症或脑膜炎的任何迹象，应考虑重复 CSF 分析，并立即开始抗菌治疗。
