Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

Shrikanth, Vandana; Salazar, Lucrecia; Khoury, Nabil; Wootton, Susan H.; Hasbun, Rodrigo

doi:10.1016/j.ijid.2015.08.001

Cited by 24 publications

(35 citation statements)

References 18 publications

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“…Additionally, we observed elevated CSF intracranial pressure, increased leukocyte count, low CSF glucose, low CSF chloride and high CSF protein levels in our study, which were consistent with previous case reports [6,8,9]. Low CSF glucose level may be related to glucose utilization by microorganisms, and the degree of hypoglycemia is directly correlated with the inflammatory process [13]. A previous study speculated that the low CSF glucose level can be used as a marker for the diagnosis of microbial meningitis [14].…”

Section: Discussionsupporting

confidence: 92%

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AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China

Dong

Shrestha

et al. 2020

AIDS Res Ther

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Background: The clinical and laboratory characteristics of AIDS-associated Talaromyces marneffei infection, a rare but a fatal mycosis disease of the central nervous system, remain unclear. Case presentation: Herein, we conducted a retrospective study of ten AIDS patients with cerebrospinal fluid culture-confirmed central nervous system infection caused by Talaromyces marneffei. All 10 patients were promptly treated with antifungal treatment for a prolonged duration and early antiviral therapy (ART). Among them, seven patients were farmers. Nine patients were discharged after full recovery, while one patient died during hospitalization, resulting in a mortality rate of 10%. All patients initially presented symptoms and signs of an increase in intracranial pressure, mainly manifesting as headache, dizziness, vomiting, fever, decreased muscle strength, diplopia or even altered consciousness with seizures in severe patients. Nine patients (90%) showed lateral ventricle dilatation or intracranial infectious lesions on brain CT. Cerebrospinal fluid findings included elevated intracranial pressure, increased leukocyte count, low glucose, low chloride and high cerebrospinal fluid protein. The median CD4 + T count of patients was 104 cells/μL (IQR, 36-224 cells/μL) at the onset of the disease. The CD4 + T cell counts of three patients who eventually died were significantly lower (W = 6.00, p = 0.020) than those of the patients who survived. Conclusions: The common clinical symptoms of T. marneffei central nervous system infection are associated with high intracranial pressure and intracranial infectious lesions. Earlier recognition and diagnosis and a prolonged course of amphotericin B treatment followed by itraconazole combined with early ART might reduce the mortality rate.

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Section: Discussionsupporting

confidence: 92%

“…Among them, one had positive results in both blood culture and bone marrow culture, one had a positive result in blood culture, and one patient had a positive result in urine culture. The median duration of CSF culture for T. marneffei was 11.5 days (IQR [6][7][8][9][10][11][12][13][14]) ( Table 2).…”

Section: Csf Profiles and Routine Blood Testmentioning

confidence: 99%

AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China

Dong

Shrestha

et al. 2020

AIDS Res Ther

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“…Despite intense experimental meningitis research in the 1960s, the pathophysiology underlying CSF glucose depletion remains controversial. Because hypoglycorrhachia is associated with higher degrees of CSF inflammation, 15 it has long been debated whether inflammation or microbial load is most responsible for depleting CSF glucose. Commonly cited mechanisms include increased glucose catabolism by leukocytes, microorganisms, or the brain parenchyma, as well as altered glucose transport across inflamed meninges.…”

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confidence: 99%

Pleocytosis is not fully responsible for low CSF glucose in meningitis

Baud

Vitt

Robbins

et al. 2018

Neurol Neuroimmunol Neuroinflamm

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Objective:The mechanism of hypoglycorrhachia—low CSF glucose—in meningitis remains unknown. We sought to evaluate the relative contribution of CSF inflammation vs microorganisms (bacteria and fungi) in lowering CSF glucose levels.Methods:We retrospectively categorized CSF profiles into microbial and aseptic meningitis and analyzed CSF leukocyte count, glucose, and protein concentrations. We assessed the relationship between these markers using multivariate and stratified linear regression analysis for initial and repeated CSF sampling. We also calculated the receiver operating characteristics of CSF glucose and CSF-to-serum glucose ratios to presumptively diagnose microbial meningitis.Results:We found that increasing levels of CSF inflammation were associated with decreased CSF glucose levels in the microbial but not aseptic category. Moreover, elevated CSF protein levels correlated more strongly than the leukocyte count with low CSF glucose levels on initial (R2 = 36%, p < 0.001) and repeated CSF sampling (R2 = 46%, p < 0.001). Hypoglycorrhachia (<40 mg/dL) was observed in 50.1% of microbial cases, but only 9.6% of aseptic cases, most of which were neurosarcoidosis. Absolute CSF glucose and CSF-to-serum glucose ratios had similar low sensitivity and moderate-to-high specificity in diagnosing microbial meningitis at thresholds commonly used.Conclusions:The main driver of hypoglycorrhachia appears to be a combination of microbial meningitis with moderate to high degrees of CSF inflammation and proteins, suggesting that the presence of microorganisms capable of catabolizing glucose is a determinant of hypoglycorrhachia in meningitis. A major notable exception is neurosarcoidosis. Low CSF glucose and CSF-to-serum glucose ratios are useful markers for the diagnosis of microbial meningitis.

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“…High blood D-dimer levels are common in chronic alcohol abusers and could be the effect of hemostatic system activation related to oxidative stress (36) . Interestingly, low concentration of glucose in the CSF was previously correlated with adverse clinical outcomes in patients with BM (37) .…”

Section: Discussionmentioning

confidence: 96%

Chronic alcohol abuse affects the clinical course and outcome of community-acquired bacterial meningitis

Paciorek

Bednarska

Krogulec

et al. 2019

Preprint

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Background:The aim of the study was to determine the effect of chronic alcohol abuse on the course and outcome of bacterial meningitis (BM). Materials/methods:We analyzed records of patients with BM who were hospitalized between January 2010 and December 2017 in the largest neuroinfection center in Poland.Results: 340 adult patients (211 men and 129 women) were analyzed. Forty-five (13.2%) patients were alcoholics (39 men and 6 women). Compared to non-alcoholics, alcoholics were more likely to present with seizures (33.3% vs 12.6%, p<0.001), scored higher on the Sequential Organ Failure Assessment (SOFA) (median 3 vs 2, p<0.001) and lower on the Glasgow Coma Scale (GCS) (median 10 vs 12, p<0.001) and had worse outcome as measured by the Glasgow Outcome Score (GOS) (median 3 vs 5, p<0.001). Furthermore, alcoholics were less likely to complain of headache (23.3% vs 52.3%, p<0.001) and nausea/vomiting (11.4% vs 33.6%, p=0.005) and had lower concentration of glucose in cerebrospinal fluid (CSF) (median 0,58 mmol/L vs 1,97, p=0.025). In the multiple logistic regression analysis, alcoholism was independently associated with lower GCS (OR 0.716, 95% CI 0.523-0.980, p=0.036), presence of seizures (OR 4.580, 95% CI 1.065-19.706, p=0.041), male gender (OR 4.617, 95% CI 1.060-20.113, p=0.042) and absence of nausea/vomiting (OR 0.205, 95%CI 0.045-0.930, p=0.040). Furthermore, alcoholism (regression coefficient [-0.636], 95% CI [-1.21] -[-0.06], p=0.031), lower GCS score (regression coefficient 0.144, 95% CI 0.06-0.23, p=0.001) and higher urea blood concentration (regression coefficient [-0.052], 95% CI [-0.10] -[-0.01], p=0.018) were independently associated with worse outcome measured by GOS.Conclusions: Compared to non-alcoholics, chronic alcohol abusers are more likely to present with seizures, altered mental status, higher SOFA score and have an increased risk of unfavorable outcome. In multivariate analysis seizures and low GCS were independently 3 associated with alcoholism, while alcoholism was independently associated with worse outcome.

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Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance

Cited by 24 publications

References 18 publications

AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China

AIDS-associated Talaromyces marneffei central nervous system infection in patients of southwestern China

Pleocytosis is not fully responsible for low CSF glucose in meningitis

Chronic alcohol abuse affects the clinical course and outcome of community-acquired bacterial meningitis

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