Approach to Diagnosis of Meningitis Cerebrospinal Fluid Evaluation

Greenlee, John

doi:10.1016/s0891-5520(20)30367-6

Cited by 76 publications

(5 citation statements)

References 72 publications

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“…Of culture-positive specimens, 75%– 90% of CSF are Gram stain positive, decreasing to 40%–60% in patients who have received antibiotics prior to lumbar puncture [ 27 , 28 ]. The Gram stain is rapid and cheap, but clinical utility depends on bacterial load and the pathogen [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008–2017

Plessis

Gouveia

Freitas

et al. 2021

The Journal of Infectious Diseases

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Background As part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa’s regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS). Methods From 2008 to 2017, CSF samples collected from children <5 years old with suspected meningitis underwent routine microbiology testing in-country, and 11 680 samples were submitted for HNS PCR at the regional reference laboratory. Unconditional logistic regression, with adjustment for geographic location, was performed to identify factors associated with PCR positivity. Results The overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67–8.17) and xanthochromic (1.72; 1.29–2.28), had elevated white blood cell counts (6.13; 4.71–7.99) and high protein concentrations (5.80; 4.34–7.75), and were more often HNS culture positive (32.70; 23.18–46.12). Conclusion PCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

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Section: Discussionmentioning

confidence: 99%

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008–2017

Plessis

Gouveia

Freitas

et al. 2021

The Journal of Infectious Diseases

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“…Bacteria, mycobacteria, and fungal diseases are created from CSF variations that may incredibly encourage conclusion and direct introductory treatment. All patients with acute bacterial meningitis ought to be performed the fundamental investigations of CSF include cell count, measurement of pressure, differential count of WBC, glucose, protein levels, Gram's stain properties, and cultural characteristics (Greenlee et al 2009).…”

Section: Introductionmentioning

confidence: 99%

Laboratory-Based Cytological and Biochemical Profile of Cerebrospinal Fluid for Children With Acute Bacterial Meningitis in Bangladesh

Abedin¹,

Jarin²,

Gomes

2021

J. Asiat. Soc. Bangladesh, Sci.

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An attempt was made to analyze the cerebrospinal fluid (CSF) for a cytological and biochemical profile to identify etiological agents from children with suspected acute bacterial meningitis. The cerebrospinal fluid (CSF) samples from 371 suspected meningitis cases were examined, and the highest bacterial meningitis was found in 52(14.0%) cases in this study. Among a total of 371 samples of CSF, 272(73.3%) were crystal clear, 52(14.0%) were moderately turbid, 47(12.7%) highly turbid. The total leukocyte cell count of the CSF was proportionate to the turbidity. In the case of crystal clear CSF’s, total leukocyte counts (TLC) were normally ranging from <5 to 45 per mm3 with predominant lymphocytes. Moderately turbid fluid showed 46 to 500 cells per mm3 and highly turbid fluid showed from 501 to more than 10,00 cells/mm3. In the latter cases, differential counts demonstrated polymorphonuclear predominance. In addition, about 100% (52 cases) of positive and 12.5% (40/319) of negative cases had CSF protein concentration >100 mg/dL. CSF protein concentration greater than 100 mg/dl and sugar level below 40 mg/dl were considered as suspected bacterial meningitis in this study. Surprisingly, the C-Reactive Protein (CRP) values were found to be >40 mg/dL in both culturally positive and negative cases. Most of meningitis positive cases showed increased total cell counts as well as protein concentration, and decreased serum sugar concentrations. J. Asiat. Soc. Bangladesh, Sci. 47(2): 137-147, December 2021

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“…CSF samples were extensively assessed for white blood cells (WBC), proteins, and glucose levels using bacterial cultures and Gram stain. Acid-fast staining and India ink/cryptococcal antigen preparation were done in order to detect tuberculosis or Cryptococcus neoformans , respectively ( 16 ). Polymerase chain reaction was carried out in the CSF to assess for the presence of viral causes of meningitis.…”

Section: Methodsmentioning

confidence: 99%

Meningoencephalitis associated with GAD65 autoimmunity

Kuang

Baizabal‐Carvallo²,

Mofatteh³

et al. 2023

Front. Immunol.

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BackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to define the frequency, clinical features, response to therapy, and functional outcomes of patients with meningoencephalitis associated with GAD antibodies.MethodsWe retrospectively studied consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder from January 2018 to June 2022. The modified Rankin Scale (mRS) was used to assess the functional outcome at the last follow-up.ResultsWe evaluated 482 patients with confirmed autoimmune encephalitis during the study period. Four among the 25 patients with encephalitis related to GAD65 antibodies were identified. One patient was excluded owing to the coexistence of NMDAR antibodies. Three male patients aged 36, 24, and 16 years had an acute (n = 1) or subacute (n = 2) onset of confusion, psychosis, cognitive symptoms, seizures, or tremor. No patient had fever or clinical signs of meningeal irritation. Mild pleocytosis (<100 leukocytes/106) was identified in two patients, whereas one patient had normal CSF. Following immunotherapy with corticosteroids (n = 3) or intravenous immunoglobulin (n = 1), significant improvement was observed in all three cases, achieving a good outcome (mRS 1) in all cases.ConclusionMeningoencephalitis is an uncommon presentation of GAD65 autoimmunity. Patients present with signs of encephalitis but with meningeal enhancement and have good outcomes.

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Approach to Diagnosis of Meningitis Cerebrospinal Fluid Evaluation

Cited by 76 publications

References 72 publications

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008–2017

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008–2017

Laboratory-Based Cytological and Biochemical Profile of Cerebrospinal Fluid for Children With Acute Bacterial Meningitis in Bangladesh

Meningoencephalitis associated with GAD65 autoimmunity

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