Cerebrospinal Fluid Protein Concentration in Pediatric Patients

Wong, Michael; Schlaggar, Bradley L.; Buller, Richard S.; Storch, Gregory A.; Landt, Michael

doi:10.1001/archpedi.154.8.827

Cited by 50 publications

(44 citation statements)

References 12 publications

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“…Pleocytosis was defined as a CSF cell count of Ͼ22 cells/mm 3 if the patient's age was Ͻ4 weeks, Ͼ15 cells/mm 3 if the patient's age was 4 to 8 weeks, and Ͼ5 cells/mm 3 if the patient's age was Ͼ8 weeks (1). The cutoffs to identify elevated levels of CSF protein were those determined by a study at our institution in which EV RT-PCR was performed on all specimens to eliminate any samples from patients with unsuspected EV infections (19). Those cutoffs were as follows: Ն111 mg/dl for patients aged Յ2 months, Ն79 mg/dl for patients aged Ͼ2 months to 4 months, Ն34 mg/dl for patients aged Ͼ4 months to 14 years, Ն37 mg/dl for patients aged Ͼ14 years to 18 years, and Ն46 mg/dl for patients aged Ͼ18 years.…”

Section: Methodsmentioning

confidence: 99%

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

Mulford

Buller²,

Arens³

et al. 2004

J Clin Microbiol

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We found that in the group of patients aged >2 months, the absence of pleocytosis was highly predictive of a negative RT-PCR result. Elevated CSF protein level was not a good predictor of RT-PCR positivity for enterovirus and did not add to the diagnostic sensitivity or specificity of pleocytosis.Enteroviruses (EVs) cause annual seasonal epidemics of aseptic meningitis in temperate climates and are the most common cause of this clinical syndrome in the United States. The infections are most clinically noticeable in children, but they are also clearly present in adults (9). The viruses are maintained within the human population in tropical climates year-round and at low but detectable levels in both children and adults during the cold months in temperate climates (3).Reverse transcription (RT)-PCR has become the method of choice for the rapid and efficient diagnosis of EV infections from cerebrospinal fluid (CSF). The use of commercially available (6,11,12,20) and in-house assay methods (6) is currently common in molecular diagnostic virology laboratories and often results in fewer tests being performed, less medication being used, and earlier release from the hospital than with previous diagnostic methods for patients with CSF samples with positive RT-PCR results for EV (EV RT-PCR) and negative Gram stains (4,8,10,14,15).Whether CSF pleocytosis plays an important role in defining aseptic meningitis or in prioritizing the differential diagnosis has been investigated but is still not completely clear (7,14,17). In this era of rapidly rising health care costs, it is important, if possible, to limit laboratory-based testing by encouraging syndrome-directed testing and actively discouraging testing that is not consistent with the clinical picture or with other laboratory results. Additionally, quality control within the laboratory can be enhanced by monitoring laboratory-based data to look for important correlations that will provide insight for clinicians and laboratory workers with regard to future testing requests.During the 2001, 2002, and 2003 EV seasons, we collected all available CSF cell count data and CSF protein data (available for 2001 and 2002 only) for patients for whom EV RT-PCR of CSF samples had been requested. Our suspicion that CSF with a nucleated cell count of Յ5 per mm 3 from patients more than 2 months old was not likely to be RT-PCR positive proved to be true, although a large number of CSF samples with high cell counts did not test positive for EV. MATERIALS AND METHODSCSF specimens (n ϭ 1,706) were submitted to the St. Louis Children's Hospital Virology Laboratory during the 2001, 2002, and 2003 EV seasons (roughly May to November of each year) for EV RT-PCR testing. Relevant CSF cell count data was available from the laboratory information system for 728 of the patients who were seen at Washington University Medical Center and tested by EV RT-PCR. Of the patients included in the study, 549 were pediatric (Յ18 years of age) and 179 were adults. The data analyzed included patient age, EV RT-PC...

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Section: Methodsmentioning

confidence: 99%

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

Mulford

Buller²,

Arens³

et al. 2004

J Clin Microbiol

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“…CSF samples were included in this study providing they revealed a typical profile of aseptic meningitis with elevated levels of protein (Ͼ0.45 g/liter) and/or nuclear cells (Ͼ6 cells/mm 3 ), normal glucose levels, negative Gram stain results, and negative bacterial and fungi cultures (15). Virus isolation had been prospectively performed for each CSF sample on human diploid fibroblasts (MRC-5) and rhesus monkey kidney cells (MA-104) as previously described (7).…”

mentioning

confidence: 99%

New Reverse Transcription-PCR Assay for Rapid and Sensitive Detection of Enterovirus Genomes in Cerebrospinal Fluid Specimens of Patients with Aseptic Meningitis

et al. 2003

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Enterovirus (EV) detection by a new commercially available reverse transcription (RT)-PCR assay (Penter RT-PCR test) was compared with EV isolation from cell cultures and with EV detection by an in-houseEnteroviruses (EVs) of the Picornaviridae family (64 distinct serotypes) are etiological causes of neurological syndromes in infants and adults (9,14). Aseptic meningitis is the most common EV-related central nervous system syndrome and may be difficult to distinguish from meningitis caused by herpesviruses or bacteria, particularly in young infants and children (9, 10). When classical cell culture techniques are used, attempts to isolate EVs from cerebrospinal fluid (CSF) samples are frequently unsuccessful because of the low viral titers in clinical specimens and because some serotypes grow poorly in cell culture (3, 4). Therefore, in-house PCR techniques for the detection of the EV genome have been introduced, allowing sensitive and rapid identification of EV-infected CSF samples (1,11,12,17) and improving the management of young infants with meningitis (8). However, the application of in-house EV PCR assays to the clinical diagnosis of EV-related neurological syndromes is actually limited by the time-consuming methods and the lack of standardization of procedures (6, 13). In this study, a new commercially available and well-standardized reverse transcription (RT)-PCR test (Penter RT-PCR) (2) was compared with cell culture and with an inhouse reference RT-PCR assay for the detection of EV in CSF of patients with aseptic meningitis.Fifty-four archived CSF specimens taken from 49 children (mean age, 6 years; range, 10 days to 12 years) and 5 adults (mean age, 29 years; range, 19 to 33 years) hospitalized at the university hospital of Reims (Reims, France) for meningitis syndrome during a summer outbreak of aseptic meningitis (May to November 2001) were retrospectively selected. CSF samples were included in this study providing they revealed a typical profile of aseptic meningitis with elevated levels of protein (Ͼ0.45 g/liter) and/or nuclear cells (Ͼ6 cells/mm 3 ), normal glucose levels, negative Gram stain results, and negative bacterial and fungi cultures (15). Virus isolation had been prospectively performed for each CSF sample on human diploid fibroblasts (MRC-5) and rhesus monkey kidney cells (MA-104) as previously described (7). EV isolates were typed by the standard method of virus neutralization (Lim-Banyesch-Melnick immune serum pools) (4). After testing of CSF by viral culture, aliquots of CSF were stored at Ϫ80°C for later use in detecting enteroviral RNA by RT-PCR.The new EV Penter RT-PCR test (new-generation EV consensus kit; Argène Biosoft, Varhiles, France) utilized several pairs of stair primers selected for annealing in the 5Ј untranslated region, which is highly conserved in the EV group (2), and was used according to the manufacturer's instructions. Briefly, viral RNA was extracted from 140 l of CSF sample by a rapidextraction protocol (viral RNA minikit; Qiagen, Courtaboeuf, France) and elute...

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“…Elevated protein content in CSF may be indicative of a pathologic process and levels above 1.0 g/l in neonates and 0.35 g/l in preadolescent children can be reached (Wong et al 2000).…”

Section: Test Liquids For Characterisation Of Protein Adsorptionmentioning

confidence: 99%

Development and in-vitro characterization of an implantable flow sensing transducer for hydrocephalus

Bork¹,

Hogg²,

Lempen

et al. 2010

Biomed Microdevices

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An implantable transducer for monitoring the flow of Cerebrospinal fluid (CSF) for the treatment of hydrocephalus has been developed which is based on measuring the heat dissipation of a local thermal source. The transducer uses passive telemetry at 13.56 MHz for power supply and read out of the measured flow rate. The in vitro performance of the transducer has been characterized using artificial Cerebrospinal Fluid (CSF) with increased protein concentration and artificial CSF with 10% fresh blood. After fresh blood was added to the artificial CSF a reduction of flow rate has been observed in case that the sensitive surface of the flow sensor is close to the sedimented erythrocytes. An increase of flow rate has been observed in case that the sensitive surface is in contact with the remaining plasma/artificial CSF mix above the sediment which can be explained by an asymmetric flow profile caused by the sedimentation of erythrocytes having increased viscosity compared to artificial CSF. After removal of blood from artificial CSF, no drift could be observed in the transducer measurement which could be associated to a deposition of proteins at the sensitive surface walls of the packaged flow transducer. The flow sensor specification requirement of +-10% for a flow range between 2 ml/h and 40 ml/h. could be confirmed at test conditions of 37 degrees C.

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Cerebrospinal Fluid Protein Concentration in Pediatric Patients

Cited by 50 publications

References 12 publications

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

Correlation of Cerebrospinal Fluid (CSF) Cell Counts and Elevated CSF Protein Levels with Enterovirus Reverse Transcription-PCR Results in Pediatric and Adult Patients

New Reverse Transcription-PCR Assay for Rapid and Sensitive Detection of Enterovirus Genomes in Cerebrospinal Fluid Specimens of Patients with Aseptic Meningitis

Development and in-vitro characterization of an implantable flow sensing transducer for hydrocephalus

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