Abstract
The total peripheral white blood cell count (TPWBC) is reported to be a reliable indicator of bacterial infection. To evaluate its efficacy in the diagnosis of bacterial meningitis, we reviewed CBCs from 707 Of 735 consecutive outpatients undergoing an LP on clinical suspicion of underlying CNS infection at Yale-New Haven (n=343) and Cleveland Metropolitan General Hospitals (n=364). The 26 children with bacterial meningitis (BM) had a median TPWBC not significantly different from the 66 children with aseptic meningitis, or the 568 children with other illnesses (10.8 vs 11.0 and 11.6 × 103, p>.05), but significantly less than the median TPWBC of 47 children with an extracranial bacterial infection(EBI) [10.8 vs 17.9 x103, p=.005]. Findings remained unchanged when the TPWBC distributions were adjusted for differences in age, temperature and presence of bacteremia among patients. Regarding bacteremia, the median TPWBC among patients with BM was significantly lower than that among patients with EBI (p=.007). Patients with BM and H.influenzae bacteremia had significantly lower median TPWBC than patients with EBI and H.influenzae bacteremia (p=.01). Logistic regression analysis demonstrated that the TPWBC alone was a poor predictor of BM and added no additional predictive power when combined with the results of the routine CSF examination.
We conclude that the TPWBC is of limited value to clinicians when assessing the risk of bacterial meningitis in children suspected of CNS infection, and is of no value in differentiating septic from an aseptic CSF pleocytosis.
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Lembo, R., Rubin, D. & McCarthy, P. DIAGNOSTIC EFFICACY OF THE TOTAL PERIPHERAL WBC COUNT IN CHILDREN SUSPECTED OF CNS INFECTION. Pediatr Res 21 (Suppl 4), 285 (1987). https://doi.org/10.1203/00006450-198704010-00705
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DOI: https://doi.org/10.1203/00006450-198704010-00705