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Meningococcal meningitis and a negative cerebrospinal fluid: Case report and its medicolegal implications
Author(s) -
Huynh William,
Lahoria Rajat,
Beran Roy G,
Cordato Dennis
Publication year - 2007
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2007.01032.x
Subject(s) - medicine , cerebrospinal fluid , neisseria meningitidis , meningitis , lumbar puncture , bacterial meningitis , meningococcal meningitis , antimicrobial , intensive care medicine , pediatrics , microbiology and biotechnology , bacteria , genetics , biology
A normal result on the initial cerebrospinal fluid (CSF) study has been traditionally used to exclude the potential diagnosis of bacterial meningitis. However, there have been a number of case studies of bacterial meningitis confirmed by CSF culture, in which an initial lumbar puncture yielded completely normal parameters. A review of the literature reports the frequency of this scenario to arise in 0.5% to 12% of cases. This might result in the delay of appropriate treatment for this potentially fatal condition. We report a 21‐year‐old female patient who presented with a clinical picture compatible with bacterial meningitis but with a normal initial CSF result. Neisseria meningitidis was later cultured from her CSF. The medicolegal aspects surrounding such a scenario, and its implications towards clinical practice are discussed. We conclude that an abnormal initial CSF study might indicate a diagnosis of bacterial meningitis but a normal result does not exclude it and should not delay early institution of appropriate antimicrobial therapy.