Meningitis: reagent strips helped diagnose.

Clinical bottom line (level 2b)

  1. A half of patients suspected of having viral or bacterial meningitis had it.
  2. Patients with a positive reagent strip test were much more likely to have meningitis.
  3. Patients with a negative reagent strip were less likely to have meningitis.
Moosa et al: Lancet 1995; 345: 1290-1291
Expires June 2003

The study

Setting: Paediatric department of a university hospital, Kuwait

234 patients (aged ?, ?% male) suspected meningitis

Independent blinded reference standard, applied in all patients from a ?consecutive ?appropriate spectrum.
Reference standard:
  • laboratory values of CSF glucose, protein and leucocytes
Diagnostic test: reagent strips- CSF was put onto the glucose, protein and leucocyte patches and was washed off after 60 seconds. The colour change was read against the standards provided. The presence of leucocytes was graded as negative, 10-25, 75 and 500 µ L; protein as 30, 100 and 500 g/L; glucose <2.8, 2.8 and 5.5 mmol/L.

The evidence


diagnostic test bacterial or viral meningitis no meningitis LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
reagent strip '+ve' 127 2 49.0
( to ) 		98.0% 0.02
( to ) 		2.00%
total 129 105

  • Bacterial meningitis 'positive' test; Glc <2.8 mmol/L & prot > 500g/L and any cells: Glc >2.8 mmol/L prot > 500 g/L and cells > 500/microL
  • Viral meningitis 'positive' test; Glc 2.8 to 5.5 mmol/L, with any prot, and cells 10-75/microL

Comments

  1. Uncertain if all CSF from sequential patients or sequential LPs.
  2. This trial was carried out on children, but does not indicate what age of children.
  3. The efficacy of the dipstick in differentiating bacterial from tubercular meningitis also has to be established.

Citation

  1. Moosa AA, Quortum HA, Ibrahim MD: Rapid diagnosis of bacterial meningitis with reagent strips. Lancet 1995; 345: 1290-1291
Contributor: Clare Wotton and Bob Phillips, November 1999
Reviewer: Shally Awasthi

Clinical Question.
Patient suspected meningitis
Intervention or Exposure reagent strips
Comparison routine laboratory diagnostic evaluation
Outcome diagnosis