Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

Abstract

Background We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Methods Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n=193) and a retrospective validation (n=567) cohort. Clinically related baseline characteristics were grouped into three composite variables, each independently associated with a set of predefined urgent treatable causes. We subsequently derived a risk score classifying patients into low (0 composite variables present) or high ( ≥ 1 composite variables present) risk for an urgent treatable cause. The sensitivity of the risk score was determined in the validation cohort and in a prospective case series of 214 adults with CSF-culture proven bacterial meningitis, CSF pleocytosis and a negative Gram stain. Findings A total of 41 of 193 patients (21%) in the derivation cohort and 71 of 567 (13%) in the validation cohort had an urgent treatable cause. Sensitivity of the dichotomized risk score to detect an urgent treatable cause was 100.0% (95%CI 93.9-100.0%) in the validation cohort and 100.0% (95%CI 97.8-100.0%) in bacterial meningitis patients. Interpretation The risk score can be used to identify adults with CSF pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause.

Bacterial Profile and their Antimicrobial Resistance Patterns from Body Fluids at Tikur Anbesa Specialized Hopital, Addis Ababa, Ethiopia

“…Out of 384 body fluids, 45.1% (n=173/384) of it had relatively high number of white blood cell count (WBC) above 05 cells/mm 3 and of them 21.1% (n=92/384) of body fluids had a polymorphic differential WBC features. All body fluids, which were positive by culture, had WBC count of above 20 cells/mm 3 with dominant polymorphic differential features in 72.9% (n=39/54) of body fluids. About 79.6% (n=43/54) of culture positive body fluids were turbid in appearance and only 11.1% of body fluids (n=6/54) had clear appearance and yield positive cultures.…”

“…Generally, body fluids like cerebrospinal fluid (CSF), pleural, peritoneal, synovial and pericardial fluids are naturally free of microorganisms under normal circumstance [2]. However, under infectious condition of central nervous system, peritoneum, joints and other sterile sites, different types of bacteria, fungi, virus and parasites could present and change the physicochemical nature of the body fluids [1][2][3].…”

“…CSF is produced by ultra-filtration or secretion, and circulates through the ventricles and spinal cord and supply nutrients to brain cell and serve as a cushion [3]. Bacterial meningitis is a medical emergency that require urgent rational antibiotics therapy.…”

Aseptic meningitis in adults and children: Diagnostic and management challenges

“…Varicella zoster virus and Cytomegalovirus have also been described as causes of aseptic meningitis [2]. Several prior studies have sought to develop clinical models to try to differentiate this diagnosis from other urgent treatable conditions such as bacterial meningitis and encephalitis [3–4]. To standardize the case definition, a recent international working group defined aseptic meningitis as patients with meningitis symptoms, a CSF white cell count of >5 cells/mm3, and a negative CSF Gram stain [5].…”

Cerebrospinal Fluid in Clinical Neurology

“…More than 90 % of patients with acute bacterial meningitis show a CSF pleocytosis of more than 1,000/μl: only in the very old or immunocompromised patient the leucocyte count in the CSF might be low or even very low. With the normal CSF glucose concentration being approximately 60-70 % of the serum glucose, any CSF/serum glucose Brouwer et al 2012 ;Glimåker et al 2013a ;Heckenberg et al 2014 ;Roos and van de Beek 2010 ) ratio below 0.4 is considered indicative of acute bacterial meningitis (Glimåker et al 2013a ;Hasbun et al 2013 ;Heckenberg et al 2014 ;Roos and van de Beek 2010 ;Welch and Hasbun 2010 ). CSF Gram stain, CSF PCR and CSF culture are essential components for diagnosing acute bacterial meningitis.…”