Case 1 was a 34-year-old Japanese woman with a history of splenectomy who presented with pyrexia, nausea, headache, and loss of hearing in her right ear. Patients with meningitis caused by Streptococcus pneumoniae and hyponatremia were at a higher risk of mortality and the development of sequelae. CSF glucose has also been previously stated as a parameter for the differentiation between bacterial meningitis and Tuberculous meningitis . We here report two cases of adult patients with pneumococcal meningitis with a normal cerebrospinal fluid leukocyte count and review eight other cases in the literature. 11 – 13 Similar findings have been defined for urine cultures. Bacterial meningitis was ultimately diagnosed in 217 of the patients. For information on performing a lumbar puncture and sampling, see the separate Lumbar Puncturearticle. The lower glucose in Haemophilus influenzae type b may possibly be an indirect measure of the level of … It may result from infections, other disorders, or reactions to drugs. Table 2: Cerebrospinal Fluid Analysis Findings: CSF Characteristic: Normal Range: Suggestive of Bacterial Meningitis: Suggestive of Viral Meningitis: Color: Clear: Cloudy: Cloudy: Red blood cell count: None: None: None: Gram stain: Negative: Usually Positive: Usually Negative (60%-90%) Pressure: Less than 200 mm H 2 O: Above normal: Normal: Protein: 15-45 mg/dL: Above normal: Above normal: Glucose < 0.6. CSF protein and WBC values may be higher and glucose values lower in neonates. The levels are usually a lot higher in bacterial meningitis. CSF lactate dehydrogenase (LDH) – is sometimes used to differentiate between bacterial and viral meningitis also. 31 Duration of treatment and choice of antibiotic Non specific findings include CBC, biochemical profile, coagulation profile and blood culture. Patients with immunocompromise, papilledema, preexisting CNS disease, new onset seizures, altered level of consciousness, and focal Escherichia coli K1 (E. coli K1) continues to be a major threat to the health of young infants. CSF C-reactive protein (CRP) is an acute phase reactant and is elevated with inflammation. Higher PCT, peripheral and CSF-leukocytosis, higher CSF-protein and lower CSF-glucose levels were more significant in bacterial than viral meningitis patients. Blood cultures and a lumbar puncture (LP) to collect CSF fluid for analysis should be performed upon suspicion of bacterial meningitis. Specific tests for bacterial meningitis include CSF analysis, CSF gram stain and culture. A CSF/serum glucose ratio < 0.4 is highly suggestive of bacterial meningitis but may also be seen in other conditions, including fungal, tuberculous, and carcinomatous meningitis. Normocellular bacterial meningitis is rarely observed in adult patients. CSF glucose levels :-very low in bacterial infections Viral meningitis 1. Non specific tests Typical CSF findings in Meningitis Bacterial meningitis 1. In bacterial meningitis it is typically lower; the CSF glucose level is therefore divided by the blood glucose (CSF glucose to serum glucose ratio). The Gram stain is positive in >60% of cases, and culture in >80%. CSF findings tend to differ by the type of meningitis but can overlap. Public Health England publishes annual reports on laboratory-confirmed invasive meningococcal disease. • Children with subdural empyema secondary to bacterial meningitis have higher protein-to-glucose ratio in the CSF, and a threshold of ˃ 4.65 was determined to … CONCLUSIONS: In children with bacterial meningitis, nontypical CSF findings and, in particular, normal CSF leukocyte count and increased protein level may indicate a worse prognosis. Note: Early during the course of viral meningitis, a neutrophilic pleocytosis may occur which evolves usually within one day to a lymphocytic pleocytosis. A ratio ≤0.4 is indicative of bacterial meningitis; in the newborn, glucose levels in CSF are normally higher, and a ratio below 0.6 (60%) is therefore considered abnormal. CSF protein level reflects the degree of meningeal inflammation:-10 X in bacterial infections 3. Latex agglutination may be positive in meningitis due to Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Escherichia coli, Group B Streptococci.Limulus lysates may be positive in Gram-negative meningitis. (P<0.0001). CSF lactate showed the best predictive ability with an area under the curve of 0.944 (95% CI 0.929 – 0.959). In one study, the mean CSF WBC count in patients with Hib meningitis previously treated with antibiotics was 5235×106/L (with 84% neutrophils), while the CSF to serum glucose ratio was 0.28 and mean CSF protein 1.37 g/L; CSF Gram stain revealed bacteria in 84% (6). Lab findings. CNS infections can cause lowered CSF glucose levels, although glucose levels are usually normal in viral infections (Table 2). CSF lactic acid - often used to distinguish between viral and bacterial meningitis. 1. In … In bacterial meningitis, the CSF glucose level (reference range, 40-70 mg/dL) is less than 40 mg/dL in 60% of patients. Any patient who presents with a reasonable likelihood of having Glucose (CSF : blood ratio) Bacterial meningitis : 100–10,000 (but may be normal) Usually < 100 >1.0 (but may be normal) <0.4 (but may be normal) Viral meningitis : Usually <100 In acute bacterial meningitis, an elevated protein level (usually 100 to 500 mg/dL) indicates blood-brain barrier injury. In this situation CSF should be sent for both PCR and bacterial antigen detection, as these are not affected by prior antibiotic administration. Characteristic findings in bacterial meningitis include a CSF glucose concentration <40 mg/dL, a CSF to serum glucose ratio of ≤0.4, a protein concentration >200 mg/dL, and a white blood cell count above 1000/microL, usually composed primarily of neutrophils [ 2,8,11 ]. Patients were dichotomized according to blood glucose level on admission. Presence of neutrophils in the CSF is associated with infection by N. meningitidis, S. pneumoniaeetc. In bacterial meningitis, the CSF glucose to serum glucose ratio is < 0.4. To investigate or exclude meningitis: bacterial, viral, tuberculous, cryptococcal, chemical, carcinomatous. A predominance of neutrophils (usually >90% PMN), a markedly low CSF glucose (also termed hypoglycorrhachia), and an elevated CSF protein are seen almost exclusively in bacterial meningitis. CSF findings in bacterial meningitis, which typically include neutrophilic pleocytosis (>1000 WBCs/mm3, > 80% of which are neutrophils), protein >100 mg/dl, and glucose < 40mg/dl. Recent studies have shown that the majority of positive blood culture findings in this population will be identified within the first 36 hours of incubation. Suspected agents should include N. meningitidis, S. pneumoniae, and H. influenzae and other pathogens in some cases. Bacterial meningitis remains a very important disease worldwide (1,2,3,4). If bacterial meningitis is suspected, CSF is the best clinical specimen to use for isolation, identification, and characterization of the etiological agents. Severity and acuity vary. CSF lactate dehydrogenase (LD) - used to differentiate between bacterial and viral meningitis. Results Out of 80 patients, infectious meningitis was confirmed in 75 cases; 38 cases were bacterial meningitis, 34 cases were viral meningitis and three cases were mixed infection. CSF glucose was significantly lower in bacterial meningitis cases (P<0.0001). The level will usually be increased with bacterial and fungal meningitis while it will remain normal or only slightly elevated with viral meningitis. It is markedly increased with bacterial meningitis. We collected data prospectively between October 1998 and April 2002, on 696 episodes of community-acquired bacterial meningitis, confirmed by culture of CSF in patients >16 years. It takes from 30 minutes to several hours for CSF glucose concentration to reach equilibrium with blood glucose concentrations; Labortary tests which may help identify the bacterial meningitis include non specific tests and specific diagnostic tests. 2. August 3, 2016. CSF glucose levels can be useful in distinguishing among causes of meningitis as more than 50% of patients with bacterial meningitis have decreased CSF glucose levels while patients with viral meningitis usually have normal CSF glucose levels. The CSF findings may be altered; Gram stain and growth of organism may be negative, however antibiotics rarely interfere with CSF protein or glucose. The CSF formula always warrants empiric antibiotic coverage. This is even more markedly so in preterm infants Any polymorphs in the CSF is unusual in the absence of meningitis A lymphocytosis may be present in bacterial meningitis and a neutrophil predominance can be seen in viral meningitis initially. A CSF glucose level of ≤ 18 mg/dL or a CSF:blood glucose ratio of < 0.23 strongly suggests bacterial meningitis. Test results that were strongly predictive of bacterial infection included cerebrospinal fluid (CSF) glucose less than 1.9 mmol/L; CSF-blood glucose ratio less than 0.23; CSF protein level greater than 2.2 g/L; or high CSF polymorphonuclear leukocyte (PMN) counts. While neutrophil-predominant pleocytosis and a decreased glucose level in CSF can predict the presence of bacterial meningitis, the CSF/blood glucose ratio is more precise (optimal cut-off=0.36, sensitivity=92.9%, specificity=92.9%, area under the curve=.97) even after administration of antimicrobials prior to examination in the emergency department. The overall annual attack rate for bacterial meningitis, as defined by a surveillance study of 27 states in the United States from 1978 through 1981, was approximately 3.0 cases per 100,000 population, although there was variability base… If patients have signs suggesting increased intracranial pressure (ICP) or a mass effect (eg, focal neurologic deficits, papilledema, deterioration in consciousness, seizures, especially if patients have HIV infection or are immunocompromised), neuroimaging—typically, contrast-enhanced CT or MRI—is done before lumbar … Findings typically include headache, fever, and nuchal rigidity, Diagnosis is by cerebrospinal fluid (CSF) analysis. One hallmark of bacterial meningitis is reduced glucose levels in the cerebrospinal fluid (CSF) of patients, which allows a physician to quickly begin appropriate antibiotic treatment. 1. Who should have a head CT prior to lumbar puncture (LP) for suspected meningitis? CSF cultures may become sterile rapidly if the pathogen was a pneumococcus or meningococcus, though cellular changes, an increase in protein, and low glucose levels persist. 6 In certain situations, a CT scan of the head is required prior to LP to exclude a mass lesion or another cause of increased intracranial pressure, which may lead to brain herniation from the procedure. However, changes in CSF glucose may lag 30 to 120 minutes behind changes in blood glucose. The approach to diagnosis includes many factors, such as symptoms; medical, medication, and exposure history; physical examination; CSF profile; and other tests (e.g., blood testing, cultures, neuroimaging, chest radiograph).1 Symptoms are nonspecific and may include headache, fever, neck pain, ataxia, lethargy, nausea, and alterations of alertness and cognitive function. Typical CSF abnormalities associated with bacterial meningitis include the following: Turbidity; Increased opening pressure (>180 mm water) Pleocytosis (usually of polymorphonuclear (PMN) leukocytes); WBC counts > 10 cells/mm 3; Decreased glucose concentration (<45 … Characteristic findings in bacterial meningitis include a CSF glucose concentration <40 mg/dL, a CSF to serum glucose ratio of ≤0.4, a protein concentration >200 mg/dL, and a white blood cell count above 1000/microL, usually composed primarily of neutrophils . A CSF:blood glucose level of < 50% suggests possible meningitis. We assessed the incidence and significance of hyperglycemia in adults with bacterial meningitis. 2. Considering a cut off of CSF lactate of 30 mg/dL, the sensitivity and specificity for bacterial meningitis were 84.1% Glucose Transporters Blocked in Bacterial Meningitis. Meningitis can be caused by bacterial, fungal or viral pathogens. 6 In bacterial meningitis, CSF findings typically … To Meningitis is inflammation of the meninges and subarachnoid space.
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