ABSTRACT
PURPOSE: The widespread introduction of bacterial conjugate vaccines has decreased the risk of cerebrospinal fluid (CSF) pleocytosis due to bacterial meningitis (BM) in children. However, most patients with CSF pleocytosis are hospitalized and treated with parenteral antibiotics for several days. The bacterial meningitis score (BMS) is a validated multivariate model derived from a pediatric population in the postconjugate vaccine era and has been evaluated in several studies. In the present study, we examined the usefulness of BMS in South Korean patients. METHODS: This study included 1,063 patients with CSF pleocytosis aged between 2 months and 18 years. The BMS was calculated for all patients, and the sensitivity and negative predictive value (NPV) of the test were evaluated. RESULTS: Of 1,063 patients, 1,059 (99.6%) had aseptic meningitis (AM). Only four patients (0.4%) had BM. The majority of patients (98%) had a BMS of or =4. CONCLUSION: To our knowledge, this is the first study to investigate the diagnostic strength of the BMS in South Korea. In our study, the BMS showed 100% sensitivity and 100% NPV. Therefore, we believe that the BMS is a good clinical prediction rule to identify children with CSF pleocytosis who are at a risk of BM.
Subject(s)
Child , Humans , Anti-Bacterial Agents , Cerebrospinal Fluid , Decision Support Techniques , Diagnosis , Korea , Leukocytosis , Meningitis, Aseptic , Meningitis, Bacterial , Vaccines, ConjugateABSTRACT
Splenectomy is a safe and effective procedure in the refractory or chronic immune thrombocytopenia (ITP) patients. Overwhelming post-splenectomy infection (OPSI) is rare but fatal. The lifetime risk of post-splenectomy patients to develop an OPSI with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae or Neisseria meningitidis) is about 1-5% and the mortality is reported more than 50% in 48 hours. Though vaccination against encapsulated bacteria cannot prevent all infection, vaccination is essential for the patients. We report a case of OPSI in a 12-year-old post-splenectomy boy who was vaccinated pneumococcal polysaccharide 7-valent against pneumococcus (Streptococcus pneumoniae) 2 months before splenectomy.
Subject(s)
Humans , Bacteria , Haemophilus influenzae , Neisseria , Pneumonia , Sepsis , Splenectomy , Streptococcus pneumoniae , Thrombocytopenia , VaccinationABSTRACT
Splenectomy is a safe and effective procedure in the refractory or chronic immune thrombocytopenia (ITP) patients. Overwhelming post-splenectomy infection (OPSI) is rare but fatal. The lifetime risk of post-splenectomy patients to develop an OPSI with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae or Neisseria meningitidis) is about 1-5% and the mortality is reported more than 50% in 48 hours. Though vaccination against encapsulated bacteria cannot prevent all infection, vaccination is essential for the patients. We report a case of OPSI in a 12-year-old post-splenectomy boy who was vaccinated pneumococcal polysaccharide 7-valent against pneumococcus (Streptococcus pneumoniae) 2 months before splenectomy.