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773 MENINGITIS OUTBREAK - LABORATORY DIFFERENTIATION OF ETIOLOGY

This study considered which initial laboratory (lab.) tests are useful in differentiating bacterial from aseptic meningitis. Between July and October, 1977, 44 children (11 days to 17 yrs. of age) with meningitis were seen. Lab. data obtained included: absolute band count (ABC), absolute polymorphonuclear count (APC), CSF glucose/blood glucose (G/BG) ratio, CSF white blood count (WBC) and differential, and CSF lactic acid dehydrogenase (LDH). Group I (7 pts., 1 pretreated) had bacteria cultured from CSF. Group II (37 pts., 0 pretreated) had sterile CSF and improved clinically without any antibiotic therapy or with only 48 hrs. of therapy pending culture reports. There was no significant difference between the APCs of the 2 groups. Group I had a higher mean ABC (p <.05), lower mean CSF G/BG ratio (p <.001), higher mean CSF WBC (p <.001), and higher mean percentage of polymorphonuclear (PMN) cells in CSF (p <.001). The overlap of ranges between the 2 groups for all these parameters limited their predictive value for individual cases. Four pts. in Group II had antibiotics withheld and repeat lumbar puncture within 6 to 32 hrs. showed an increase in CSF WBC with persistent PMN predominance. The mean CSF LDH was higher in Group I (p <.001). The CSF LDH was >60 in all Group I pts. and <60 in all Group II pts. In this outbreak of aseptic meningitis the measurement of LDH in CSF proved to be the only single test that reliably distinguished bacterial from aseptic disease.