{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T19:46:53Z","timestamp":1793908013600,"version":"4.8.0"},"reference-count":53,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>One of the main features of bacterial meningitis is pleocytosis. However, when children with meningitis present within hours of onset of symptoms, there is the possibility that the meninges are not yet sufficiently inflamed to lead to a raised cerebrospinal fluid (CSF) white blood cell count. A systematic search was done to identify published studies reporting children with culture- or polymerase chain reaction-proven bacterial meningitis in the absence of pleocytosis. We identified 26 studies describing 62 children (18 neonates). In those in whom fever duration was specified, 32 (80%) of 40 had a fever for less than or equal to 24 hours before lumbar puncture (LP). In those in whom the glucose level was reported, it was normal in 14 (82%) of 17 neonates and 33 (80%) of 41 older infants and children. The protein level was normal in 8 (44%) of 17 neonates and 32 (80%) of 40 older infants and children. Twelve of the 62 children had a Gram stain of their CSF and this was positive in 2 (17%). Simultaneous blood cultures were positive in 5 (28%) of 18 neonates and 21 (68%) of 31 older infants and children. There was no association between the absence of pleocytosis and particular bacteria. All of the 10 children who had a second LP had an abnormal CSF including pleocytosis. These findings indicate that the absence of pleocytosis does not exclude bacterial meningitis reliably and should be interpreted in the context of the duration of illness. CSF samples, particularly those from cases with relatively short symptom duration, should be cultured even when the cell count and biochemistry are normal. A second LP can be helpful when bacterial meningitis is suspected despite a normal initial CSF.<\/jats:p>","DOI":"10.1097\/inf.0000000000003085","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T16:48:30Z","timestamp":1614358110000},"page":"582-587","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":21,"title":["Bacterial Meningitis in the Absence of Pleocytosis in Children"],"prefix":"10.1097","volume":"40","author":[{"given":"Petra","family":"Zimmermann","sequence":"first","affiliation":[{"name":"Department of Paediatrics, Fribourg Hospital HFR"},{"name":"Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland"},{"name":"Department of Paediatrics, The University of Melbourne"},{"name":"Infectious Diseases Research Group, Murdoch Children\u2019s Research Institute"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel","family":"Curtis","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, The University of Melbourne"},{"name":"Infectious Diseases Research Group, Murdoch Children\u2019s Research Institute"},{"name":"Infectious Diseases Unit, The Royal Children\u2019s Hospital Melbourne, Parkville, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,2,9]]},"reference":[{"key":"R1-20250615","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/1471-2334-7-101","article-title":"Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period.","volume":"7","author":"Theodoridou","year":"2007","journal-title":"BMC Infect Dis"},{"key":"R2-20250615","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1542\/peds.2005-1132","article-title":"Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?","volume":"117","author":"Garges","year":"2006","journal-title":"Pediatrics"},{"key":"R3-20250615","first-page":"3051","article-title":"[Absence of pleocytosis in bacterial meningitis].","volume":"149","author":"Jensen","year":"1987","journal-title":"Ugeskr Laeger"},{"key":"R4-20250615","first-page":"186","article-title":"Bacterial meningitis with initial normal cerebrospinal fluid findings.","volume":"25","author":"Rosenthal","year":"1989","journal-title":"Isr J Med Sci"},{"key":"R5-20250615","first-page":"851","article-title":"Infants with meningitis without cerebrospinal fluid pleocytosis.","volume":"140","author":"Michael","year":"1986","journal-title":"Am J Dis Child"},{"key":"R6-20250615","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1097\/00006454-198711000-00008","article-title":"Bacterial meningitis presenting with normal cerebrospinal fluid.","volume":"6","author":"Polk","year":"1987","journal-title":"Pediatr Infect Dis J"},{"key":"R7-20250615","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/000992289703600607","article-title":"Meningococcal meningitis revisited: normocellular CSF.","volume":"36","author":"Sivakmaran","year":"1997","journal-title":"Clin Pediatr (Phila)"},{"key":"R8-20250615","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S0163-4453(94)91197-5","article-title":"Meningococcal meningitis with \u2018normal\u2019 cerebrospinal fluid.","volume":"29","author":"Coll","year":"1994","journal-title":"J Infect"},{"key":"R9-20250615","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/S0163-4453(95)80038-7","article-title":"Normocellular cerebrospinal fluid in meningococcal meningitis.","volume":"31","author":"Lessing","year":"1995","journal-title":"J Infect"},{"key":"R10-20250615","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1136\/bmj.1.6163.588","article-title":"Difficulties in diagnosing meningococcal meningitis in children.","volume":"1","author":"Smales","year":"1979","journal-title":"Br Med J"},{"key":"R11-20250615","doi-asserted-by":"crossref","first-page":"198.e1","DOI":"10.1016\/j.ajem.2016.07.026","article-title":"Fulminant bacterial meningitis due to Neisseria meningitidis with no pleocytosis on lumbar puncture.","volume":"35","author":"Troendle","year":"2017","journal-title":"Am J Emerg Med"},{"key":"R12-20250615","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/000992287301200216","article-title":"Acute bacterial meningitis with absent or minimal cerebrospinal fluid abnormalities. 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