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PEDIATRICS Vol. 112 No. 2 August 2003, pp. 447-448

Meningitis—Viral Versus Bacterial

Fred D. Haruda, MD
Tucson, AZ 85717-1297, USA

The first 20% of the full text of this article appears below.

To the Editor.—

The article by Nigrovic et al1 is thought-provoking but must be considered with caution by practitioners. As a child neurologist, I have seen hundreds of cases of bacterial meningitis and thousands of cases of viral meningitis. Although I have a "good feel" for which is which, I have been surprised by culture-proven bacterial meningitis with cerebrospinal fluid protein of <46 or pleiocytosis of <10. Partially treated meningitis further clouds the issue. I have also been asked to step in and pick up the pieces after someone else had guessed wrong, with catastrophic results.

I can state that I have never guessed wrong because I always treat suspected bacterial meningitis as if it was proven, a "full-court press" starting . . . [Full Text of this Article]


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