1422. Meningitis with a Negative Cerebrospinal Fluid Gram Stain in Children: A Tale of Two Cities
Session: Poster Abstract Session: CNS Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Few studies have compared the etiology, presentation and outcome of meningitis with a negative CSF Gram stain in children living in North and Central America.  

Methods:  Patients age 2 mos to 17 yrs presenting to the Emergency Departments (ED) of Children’s Memorial Hermann Hospital (CMHH) in Houston, TX and the National Children’s Hospital (NCH) in San José, CR with community-acquired meningitis [CSF WBC > 5 cells/mm3, negative Gram stain, absence of a CSF shunt or recent neurosurgery procedure (<1 mo.)] from Jan 2005 to Dec 2010 were reviewed.

Results: 329 patients were identified; 192 from CMHH and 137 from NCH. No statistically significant differences were found in age, gender, gestational age, immune status, mean duration between symptom onset and presentation as well as mean duration between presentation and computed tomography (CT) scan.  Fever and headache were the most common presenting symptoms. Laboratory evaluation differed markedly; CMHH patients underwent more diagnostic testing (enterovirus PCR, blood cultures, bacterial CSF cultures, Mycoplasma, Bartonella and West Nile Virus serologies) than NCH patients (P<0.05); CT was performed before lumbar puncture in 49% versus 17% (P=0.0024). In 74 (38.5%) of 192 CMHH patients, the etiology was identified versus 23 (16.7%) of 137 NCH patients (P =0.0001). Enterovirus (27%) and Mycoplasma(1.5%) were the most common etiologies in CMHH patients vs. Pneumococcus (4.3%) and Enterovirus (2.9%) in NCH patients. PCV7 was introduced in 2000 and PCV13 in 2010 in the US;  2009 and 2011 in CR. Empiric antibiotics were initiated in 91.1% CMHH patients versus 80.2% NCH patients; antiviral therapy (20.3 % vs. 36.4%) and steroids (9.3% vs. 42.3%) (all P<0.05). There were no differences in the outcome [discharged home (88% vs. 79.5%)], or clinical status at discharge (P>0.05).

Conclusion: Meningitis with a negative CSF Gram Stain was common in children presenting for care at 2 major referral hospitals in Houston and San José. This study illustrates the importance of including molecular detection methods to improve laboratory diagnosis in developing countries such as Costa Rica. Even though diagnostic and management approaches differed, the majority of patients had unknown etiologies and favorable outcomes.

Elizabeth A. Aguilera, MD1, Lucrecia Salazar, MD1, Alejandra Soriano, MD2, Rolando Ulloa-Gutierrez, MD2, Kattia Camacho, MD2, Marcela Hernandez, MD2, Rodrigo Hasbun, MD1 and Susan Wootton, MD1, (1)University of Texas (UT) Health, Houston, TX, (2)National Children’s Hospital “Dr. Carlos Sáenz Herrera”, San José, Costa Rica


E. A. Aguilera, None

L. Salazar, None

A. Soriano, None

R. Ulloa-Gutierrez, None

K. Camacho, None

M. Hernandez, None

R. Hasbun, None

S. Wootton, None

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