Bacterial meningitis lumbar puncture
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Bacterial meningitis Microchapters |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Lumbar puncture is the single most specific test to confirm the diagnosis of bacterial meningitis. It is indicated in all patients with suspicion of bacterial meningitis unless there is a contraindication. The CSF findings in patients with bacterial meningitis include low glucose concentration, high protein content, increased no of granulocytes and lactate levels >2.1mmol/l.[1][2]
Lumbar puncture
Indications of lumbar puncture
Lumbar puncture is indicated in all pateints with strong suspicion of meningitis for the following reasons:[3]
- To confirm the diagnosis
- To differentiate the different causes of meningitis
- To diagnose the specific causative agent for bacterial meningitis
- To start the appropriate treatment as early as possible to prevent complications
Findings of lumbar puncture in bacterial meningitis
Following CSF findings may suggest bacterial meningitis:[1][2]
- A pressure of over 180 mmH2O [1][2][4][5]
- CSF cell count in 1000s[2]
- Granulocytes > lymphocytes
- Elevated protein may range between 100-500mg/dl
- Glucose ratio (CSF/plasma) <0.3
- CSF lactate >2.1mmol/l[4][5]
- CSF gram stain findings
- Gram positive diplococcus - Streptococcus Pneumonia
- Gram negative diplococcus - Neisseria Meningitides
- Gram positive coccobacillus - Listeria Monocytogenes
- Small pleomorphic gram - negative coccobacilli - Haemophilus Influenzae
Contraindications of lumbar puncture
Contraindications of lumbar puncture may include the following:[6][3]
- Increased intracranial pressure
- Mass lesion such as tumour
- Thrombocytopenia
- Bleeding diathesis
References
- ↑ 1.0 1.1 1.2 de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
- ↑ 2.0 2.1 2.2 2.3 Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
- ↑ 3.0 3.1 Doherty CM, Forbes RB (2014). "Diagnostic Lumbar Puncture". Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.
- ↑ 4.0 4.1 Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K (2010). "Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis". Crit Care. 14 (6): R240. doi:10.1186/cc9395. PMC 3220013. PMID 21194480.
- ↑ 5.0 5.1 Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S (2011). "Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis". J Infect. 62 (4): 255–62. doi:10.1016/j.jinf.2011.02.010. PMID 21382412.
- ↑ Sempere AP, Berenguer-Ruiz L, Lezcano-Rodas M, Mira-Berenguer F, Waez M (2007). "[Lumbar puncture: its indications, contraindications, complications and technique]". Rev Neurol. 45 (7): 433–6. PMID 17918111.