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Eosinopenia as a marker of diagnosis and prognostic to distinguish bacterial from aseptic meningitis in pediatrics

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Abstract

Procalcitonin (PCT) has proven its efficacy to distinguish bacterial from aseptic meningitis in children. Nevertheless, its use in routine is limited by its cost and availability, especially in low- and middle-income countries. It is now acknowledged that eosinopenia is a marker of infection and/or severity of the systemic inflammatory response. Although no study ever demonstrated that eosinopenia could differentiate bacterial from viral infection, we decided to conduct a study concerning meningitis in children. This bicentric and retrospective study was conducted between January 2012 and October 2018, in children hospitalized for meningitis. The white blood cell was systematically gathered at the admission to evaluate the eosinophil count. Characteristic data were compared between 2 groups: documented bacterial meningitis (DBP) and aseptic meningitis which includes documented viral meningitis (DVM) and non-documented meningitis (ND). Among 190 patients admitted for meningitis, 151 were analyzed, including DBM (n = 45), DVM (n = 73), and ND (n = 33) meningitis. Groups were comparable. Mean age was 33 ± 48 months with a sex ratio of 1.6. Mean of eosinophil count was 15 ± 34/mm3 in the DBM group versus 132 ± 167/mm3 for the aseptic meningitis group (p < 0.0001). Best threshold for the diagnosis of bacterial meningitis was an eosinophil count < 5/mm3 with a sensitivity of 80% and specificity of 73% and a likelihood ratio of 2.9. Eosinopenia seems to be a reliable and non-invasive marker of bacterial meningitis in pediatrics. The absence of extra cost makes it very interesting in low- and middle-income countries or when usual biomarkers such as PCT are unavailable.

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Abbreviations

PCT:

procalcitonin

DBP:

documented bacterial meningitis

DVM:

documented viral meningitis

ND:

non-documented meningitis

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Author information

Authors and Affiliations

  1. Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Paris Ile de France Ouest, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France

    Agathe Debray, Jérome Salomon & Benjamin Davido

  2. Pédiatrie générale, Hôpital André Mignot, Le Chesnay, France

    Sylvie Nathanson

  3. Réanimation pédiatrique, Hôpital Universitaire Necker-enfants malades, AP-HP, 75015, Paris, France

    Florence Moulin

Authors
  1. Agathe Debray
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  2. Sylvie Nathanson
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  3. Florence Moulin
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  4. Jérome Salomon
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  5. Benjamin Davido
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Contributions

Dr. D and Miss D conceptualized and designed the study, carried out the initial analyses, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript.

Professor S, Drs. M and N designed the data collection instruments, collected data, and reviewed and revised the manuscript.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Benjamin Davido.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval/informed consent was not required, as part as a routine care in a retrospective observational study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Key points

An eosinophil count < 100/mm3 seems to be a relevant marker to diagnose a bacterial meningitis with a negative predictive value of 89%

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Debray, A., Nathanson, S., Moulin, F. et al. Eosinopenia as a marker of diagnosis and prognostic to distinguish bacterial from aseptic meningitis in pediatrics. Eur J Clin Microbiol Infect Dis 38, 1821–1827 (2019). https://doi.org/10.1007/s10096-019-03614-y

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  • DOI: https://doi.org/10.1007/s10096-019-03614-y

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