Evaluation of the cerebrospinal fluid samples of the patients referred with fever to pediatric emergency department and underwent to lumbar puncture

Even though central nervous system infections are frequently caused by viral agents, bacterial agents are rarely seen. Recognition of the bacterial meningitis before culture results is vital because delayed treatment may cause the risk of mortality and morbidity increase. Aim: The first aim of our study is to evaluate the performance of clinical and laboratory findings on lumbar puncture decision making. The second is to obtain predictive thresholds for bacterial and viral meningitis under the conditions of our clinic. Materials and Methods: We studied retrospectively the results of 117 patients aged between 1 month and 18 years old who referred to Istanbul University Istanbul Faculty of Medicine Pediatrics Emergency Department with fever and underwent to lumbar puncture between the dates 01.01.2014 and 30.04.2019 by using Istanbul University hospital information systems (Ishop® and ORACLE) and patients' charts. Results: From our 117 patients who underwent to lumber puncture; 13(%11.1) were diagnosed with bacterial meningitis, 17(%14.5) were diagnosed with viral meningitis, 37(%31.6) were diagnosed with suspected meningitis (aseptic meningitis) and central nervous system infection hasn't seen in 50(%42.7) of 117 patients. It is found that CRP and CSF total protein levels are statistically higher in the patients diagnosed with bacterial meningitis than viral meningitis. There was a statistically significant increase in CRP and CSF total protein values in patients with bacterial meningitis compared to patients with viral meningitis. Conclusion: Increase in the count of leukocytes in CSF is an absolute requirement to diagnose CNS infections. Even though these infections are frequently caused by viral agents; primarily PCT, CRP, CSF WBC and neutrophil counts, CSF protein level, CSF/serum glucose ratio, Gram stain help to recognise bacterial agents before the cultures result.