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In Reply: As Dr Obaro notes, some of the patients included in the aseptic meningitis group in our study did not have blood cultures obtained (although all had negative CSF cultures). Among these patients, 7 had Lyme meningitis, 79 had laboratory diagnosed enteroviral meningitis, and 253 did not have a specific diagnosis. We believe that we were correct in classifying these 253 patients as having aseptic meningitis for several reasons.

Review of the medical records of these patients revealed that none were treated with a standard course of antibiotics for bacterial meningitis (94% received 3 days of parenteral antibiotics; none received 7 days). All of these patients were discharged with a diagnosis of aseptic meningitis by their attending physicians. Patients without blood cultures obtained (n = 253) were significantly older than patients with blood cultures (n = 3041) (mean age, 9.6 vs 5.0 years; independent sample t test, P<.001). This is likely because . . . [Full Text of this Article]

Lise E. Nigrovic, MD, MPH
lise.nigrovic@childrens.harvard.edu
Division of Emergency Medicine
Children's Hospital Boston
Boston, Mass

Nathan Kuppermann, MD, MPH
Department of Emergency Medicine
University of California Davis Medical Center
Sacramento

Richard Malley, MD
Division of Infectious Diseases
Children's Hospital Boston
Boston, Mass

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Prediction Rule for Bacterial Meningitis in Children
Stephen Obaro
JAMA. 2007;297(15):1653-1654.
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Clinical Prediction Rule for Identifying Children With Cerebrospinal Fluid Pleocytosis at Very Low Risk of Bacterial Meningitis
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