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Acute Meningitis with a Negative Gram's Stain:Clinical and Management Outcomes in 171 Episodes Am J Med 100:78-84, Elmore,J.G.,et al, 1996 See this aricle in Pubmed Article Abstract One hundred sixty-eight patients(171 patient episodes)were evaluated. Almost half of the cohort presented in nonsummer months(48%);20%had concurrent comorbid disease,and 15%had identified immunocompromising conditions.The reported examination findings were diverse,with fever(49%) and neck stiffness(39%)being the most frequent findings.The majority were hospitalized(70%),with a median stay of 4 days.Approximately one half underwent computed tomography or magnetic resonance imaging(49%),and received empiric treatment with antibiotics(52%).A diagnostic caused was established in 23%,with the majority being inherently treatable diseases (including syphilis,bacteremia,Lyme disease).Variables significantly associated with a subsequent proven diagnostic cause included:age>60 years;presence of comorbid disease(especially immunodeficiency);and presentation in winter months.A large proportion of patients presenting with acute meningitis and a negative CSF Gram's stain undergo hospitalization,noninvasive cranial imaging,and receive empiric antibiotic therapy.Better clinical guidelines are needed to identify the diagnostic and management decisions that benefit patient outcome.

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(click to filter results - removes previous filter) bacteremia fever immunosuppression Lyme disease meningismus meningitis meningitis,bacterial meningitis,bacteriologic etiology of meningitis,clinical features of meningitis,neurologic aspects and complications of meningitis,spinal fluid smear and culture of meningitis,spinal fluid smear and culture-negative meningitis,syphilitic review article

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