Predictive tests to distinguish cases of bacterial meningitis

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Physicians who evaluate children with suspected meningitis have for decades sought laboratory tests which results have 100% sensitivity or 100% negative predictive value for bacterial etiology. A changing landscape of decreasing case numbers and different relative importance of bacterial pathogens hamper prospective investigation of novel tests. Dubos et al present retrospective analysis, but in a period of post-H. influenzae cases, of traditional tests plus serum C-reactive protein and procalcitonin values in 21 children with bacterial meningitis compared with 146 children with aseptic meningitis. They found that combination of tests, i.e., procalcitonin value above the threshold value of ≥0.5 mg/mL or CSF protein value ≥0.5 g/L, identified all patients with bacterial meningitis in their population. This is a useful observation that requires validation in other populations and in the pneumococcal conjugate vaccine era.