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BACKGROUND: Bacterial meningitis is a significant cause ofmorbidity and mortality in the developing world. However, limitedresearch has focused on the diagnosis and management ofmeningitis in resource-limited settings.METHODS: We designed a prospective case series of childrenadmitted to a large, academic referral hospital with acutemeningitis syndrome. Data were collected on age, time ofpresentation, prior antibiotics, cerebrospinal fluid (CSF)parameters, antibiotic and steroid prescription, and clinicaloutcome.RESULTS: Data on 99 patients were collected and analyzed. Mostof the patients were males, n=69 (70%), and were from a ruralarea, n=83 (84%). Incomplete vaccination was common, n=36(36%) and many have evidence of malnutrition, n=25 (38%). Mostpatients, n=64 (72%), had received antibiotics prior to admissionwith a mean duration of symptoms of 4.9 days prior to admission.The CSF white blood cell (WBC) count was higher in those whohad not received prior antibiotics though it was elevated in bothgroups. The CSF WBC count was not associated with survival;malnutrition and length of symptoms prior to admission were bothassociated with decreased survival.CONCLUSIONS: While use of antibiotics prior to obtaining CSFin patients with acute meningitis syndrome may decrease their CSFWBC count, it is not clinically significant. Many patients had asignificant delay in presentation that had an effect on survival,This is a potentially modifiable risk factor despite the resource-limited setting.