Mean values were compared by using the Mann-Whitney nonparametric test, the threshold of statistical significance being set at P < 0.05. The discriminative power of the various parameters studied was determined by means of receiver operating characteristic (ROC) curves. The diagnostic cut-off level for differentiation of BM and VM was defined according to the maximum value of the DZNeP Histone Methyltransf inhibitor Youden index. The ROC curves were compared by using Hanley’s method [14].ResultsBetween January 1997 and December 2009, 97 patients with BM and 218 patients with VM (183 with VM and 35 with VME) were admitted to the emergency unit of the Saint-Etienne University Hospital.

Among the 97 patients with BM, 62 cases were excluded: 42 had a positive direct CSF examination, 16 had an additional focus of infection (pulmonary (eight), in the ear, nose, and throat region (three), ascitic (two), intra-abdominal (two), one had a spondylitis with discitis), and four patients had meningitis assumed to be of bacterial origin in the absence of microbiologic documentation. In the CSF samples taken from these four patients, the polynuclear neutrophil count ranged from 964 to 1,480/mm3; protein, from 3.8 to 8.3 g/L; glucose, from 1 to 2.8 mmol/L; and lactate, from 5 to 9.2 mmol/L. These four patients received antibiotic treatment for 18 to 22 days and were cured with no sequelae. A CSF fistula was diagnosed in one of the four patients.Thirty-five patients with BM and a negative direct CSF examination were included in this study. The following bacteria were identified in CSF cultures: Streptococcus pneumoniae (14), Listeria monocytogenes (6), Neisseria meningitidis (5), Streptococcus sp.

(4), Haemophilus influenzae (2), Staphylococcus aureus (2), and other species (2). A single bacterial species was identified in the blood cultures of 14 patients.Among the 218 patients with VM, the virus was identified in 85 patients (39%): enterovirus (53), herpes virus (25), varicella zoster virus (five), and Paramyxovirus (2). In eight of these patients, admitted prior to 1999, virus identification was based on serology alone.The main clinical characteristics of the patients are presented in Table Table11.Table 1Clinical characteristics of patients on admission expressed as means (�� standard deviation) or numbers (%)The mean values of the serum parameters studied are shown in Table Table22 for each group.

With the exception of serum glucose, these values differed to a statistically significant extent between the two groups. CRP levels < 30 mg/L were noted in 10 patients in the BM group. CRP levels > 30 mg/L were seen in 25% of patients in the VM group. Only PCT values showed no overlap between the BM and VM groups. However, two patients with BM (bacterial species identified: Listeria Anacetrapib monocytogenes and Haemophilus influenzae, respectively) had low PCT values: 0.20 and 0.28 ng/ml.