A 20 month old presented with 1-day history of temperature, off food and ‘not herself’. Clinical examination showed a slightly irritable child with temperature 38.8⁰C, slightly congested throat and doubtful neck stiffness. An LP shows WCC 2, RCC 0. A diagnosis of viral illness is made, and antibiotics are not commenced.

Brave? Stupid? Evidence based? Drs Ray & Rylance from Newcastle give us this provocative scenario.

Can a relatively normal CSF – indeed can a completely white-cell free CSF – be relied on to rule out menigitis?

And if it can’t, do we need to change how we practice?

Acknowledgement:

Photo from http://flickr.com/photos/26837176@N00/481711124/ under creativecommons 2.0