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Background and objectives: <p>Meningitis diagnosis requires a lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) for a laboratory-based analysis. In high-income settings, LPs are part of the systematic approach to screen for meningitis, and most yield negative results. In low- and middle-income settings, LPs are seldom performed, and suspected cases are often treated empirically. The aim of this study was to validate a non-invasive transfontanellar white blood cell (WBC) counter in CSF to screen for meningitis.</p> Methods: <p>We conducted a prospective study across three Spanish hospitals, one Mozambican and one Moroccan hospital (2020–2023). We included patients under 24 months with suspected meningitis, an open fontanelle, and a LP performed within 24 h from recruitment. High-resolution-ultrasound (HRUS) images of the CSF were obtained using a customized probe. A deep-learning model was trained to classify CSF patterns based on LPs WBC counts, using a 30cells/mm<sup>3</sup> threshold.</p> Results: <p>The algorithm was applied to 3782 images from 76 patients. It correctly classified 17/18 CSFs with <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\ge\)</EquationSource> <EquationSource Format="MATHML"><math> <mo>≥</mo> </math></EquationSource> </InlineEquation>30 WBC, and 55/58 controls (sensitivity 94.4%, specificity 94.8%). The only false negative was paired to a traumatic LP with 40 corrected WBC/mm<sup>3</sup>.</p> Conclusions: <p>This non-invasive device could be an accurate tool for screening meningitis in neonates and young infants, modulating LP indications.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Our non-invasive, high-resolution ultrasound device achieved 94% accuracy in detecting elevated leukocyte counts in neonates and infants with suspected meningitis, compared to the gold standard (lumbar punctures and laboratory analysis).</p> </ItemContent> <ItemContent> <p>This first-in-class screening device introduces the first non-invasive method for neonatal and infant meningitis screening, potentially modulating lumbar puncture indications.</p> </ItemContent> <ItemContent> <p>This technology could substantially reduce lumbar punctures in low-suspicion cases and provides a viable alternative critically ill patients worldwide or in settings where lumbar punctures are unfeasible, especially in low-income countries).</p> </ItemContent> </UnorderedList></p>

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Non-invasive meningitis screening in neonates and infants: multicentre international study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月23日

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  • Sara Ajanovic,
  • Beatrice Jobst,
  • Javier Jiménez,
  • Rita Quesada,
  • Fabião Santos,
  • Francesc Carandell,
  • Manuela Lopez-Azorín,
  • Eva Valverde,
  • Marta Ybarra,
  • María Carmen Bravo,
  • Paula Petrone,
  • Hassan Sial,
  • David Muñoz,
  • Thais Agut,
  • Barbara Salas,
  • Nuria Carreras,
  • Ana Alarcón,
  • Martín Iriondo,
  • Carles Luaces,
  • Muhammad Sidat,
  • Mastalina Zandamela,
  • Paula Rodrigues,
  • Dulce Graça,
  • Sebastião Ngovene,
  • Justina Bramugy,
  • Anelsio Cossa,
  • Campos Mucasse,
  • William Chris Buck,
  • Sara Arias,
  • Chaymae El Abbass,
  • Houssain Tligi,
  • Amina Barkat,
  • Alberto Ibáñez,
  • Montserrat Parrilla,
  • Luis Elvira,
  • Cristina Calvo,
  • Adelina Pellicer,
  • Fernando Cabañas,
  • Quique Bassat,
  • Ajanovic Sara,
  • Bassat Quique,
  • Petrone Paula,
  • Sial Hassan,
  • Maixenchs Maria,
  • Amroune Carole,
  • Aerts Céline,
  • Valverde Eva,
  • Ybarra Marta,
  • M. Carmen Bravo,
  • Pellicer Adelina,
  • Lopez-Azorín Manuela,
  • Cabañas Fernando,
  • Muñoz David,
  • Agut Thais,
  • Salas Barbara,
  • Carreras Nuria,
  • Alarcón Ana,
  • Iriondo Martín,
  • Luaces Carles,
  • Zandamela Mastalina,
  • Rodrigues Paula,
  • Graça Dulce,
  • Ngovene Sebastião,
  • Bramugy Justina,
  • Cossa Anelsio,
  • Machai Janeta,
  • Mucasse Campos,
  • W. Chris Buck,
  • Martins Luzidina,
  • Massango Sandra,
  • Arias Sara,
  • El Abbass Chaymae,
  • Barkat Amina,
  • Tligui Houssain,
  • Amalik Najat,
  • Zizi Imane,
  • Jobst Beatrice,
  • Jimenez Javier,
  • Quesada Rita,
  • Santos Fabião,
  • Carandell Francesc

摘要

Background and objectives:

Meningitis diagnosis requires a lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) for a laboratory-based analysis. In high-income settings, LPs are part of the systematic approach to screen for meningitis, and most yield negative results. In low- and middle-income settings, LPs are seldom performed, and suspected cases are often treated empirically. The aim of this study was to validate a non-invasive transfontanellar white blood cell (WBC) counter in CSF to screen for meningitis.

Methods:

We conducted a prospective study across three Spanish hospitals, one Mozambican and one Moroccan hospital (2020–2023). We included patients under 24 months with suspected meningitis, an open fontanelle, and a LP performed within 24 h from recruitment. High-resolution-ultrasound (HRUS) images of the CSF were obtained using a customized probe. A deep-learning model was trained to classify CSF patterns based on LPs WBC counts, using a 30cells/mm3 threshold.

Results:

The algorithm was applied to 3782 images from 76 patients. It correctly classified 17/18 CSFs with \(\ge\) ≥ 30 WBC, and 55/58 controls (sensitivity 94.4%, specificity 94.8%). The only false negative was paired to a traumatic LP with 40 corrected WBC/mm3.

Conclusions:

This non-invasive device could be an accurate tool for screening meningitis in neonates and young infants, modulating LP indications.

Impact

Our non-invasive, high-resolution ultrasound device achieved 94% accuracy in detecting elevated leukocyte counts in neonates and infants with suspected meningitis, compared to the gold standard (lumbar punctures and laboratory analysis).

This first-in-class screening device introduces the first non-invasive method for neonatal and infant meningitis screening, potentially modulating lumbar puncture indications.

This technology could substantially reduce lumbar punctures in low-suspicion cases and provides a viable alternative critically ill patients worldwide or in settings where lumbar punctures are unfeasible, especially in low-income countries).