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We read with interest the recent article by Ray et al [1] regarding the accuracy of cerebrospinal fluid (CSF) results to differentiate bacterial from aseptic meningitis in case of negative Gram stain. As the authors state, their results are of great value because they address the real issue faced by practicing physicians when they have to distinguish bacterial from aseptic meningitis. Indeed, if bacteria are seen on the Gram stain, the diagnosis of bacterial meningitis can be made with confidence [2].

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