Fungal meningitis laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
Line 3: Line 3:
{{CMG}}; {{AE}} [[User:Rim Halaby|Rim Halaby]]; {{PTD}}
{{CMG}}; {{AE}} [[User:Rim Halaby|Rim Halaby]]; {{PTD}}
==Overview==
==Overview==
A lumbar puncture is essential for the diagnosis of fungal meningitis and initiation of the appropriate treatment. The [[cerebrospinal fluid]] (CSF) of a patient having [[fungal meningitis]] is distinguished by the presence of lymphocytosis, low glucose level and high proteins level. Specific CSF stains and cultures as well as serologies help in determining the specific nature of the causative fungi.
A [[lumbar puncture]] is essential for the diagnosis of [[fungal meningitis]] and initiation of the appropriate treatment. The [[cerebrospinal fluid]] (CSF) of a patient having [[fungal meningitis]] is distinguished by the presence of [[lymphocytosis]], low glucose level and high proteins level. Specific [[CSF]] stains and cultures as well as serologies help in determining the specific nature of the causative fungi.
Biopsy of skin lesions, chest radiography, ophthalmologic examination, computed tomography or MRI of the brain, in addition to cultures of CSF, blood, and sputum, may provide essential diagnostic clues.
Biopsy of skin lesions, chest radiography, [[ophthalmologic]] examination, computed tomography or [[MRI]] of the brain, in addition to cultures of [[CSF]], blood, and sputum, may provide essential diagnostic clues.


==Laboratory Findings==
==Laboratory Findings==
===The General Characteristic CSF Findings in Fungal Meningitis:===
===The General Characteristic CSF Findings in Fungal Meningitis:===


Analysis of the CSF in suspected fungal meningitis should include:<ref name="pmid1569350">{{cite journal| author=White M, Cirrincione C, Blevins A, Armstrong D| title=Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease. | journal=J Infect Dis | year= 1992 | volume= 165 | issue= 5 | pages= 960-3 | pmid=1569350 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1569350  }} </ref><ref name="pmid23083311">{{cite journal| author=Pettit AC, Kropski JA, Castilho JL, Schmitz JE, Rauch CA, Mobley BC et al.| title=The index case for the fungal meningitis outbreak in the United States. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 22 | pages= 2119-25 | pmid=23083311 | doi=10.1056/NEJMoa1212292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23083311  }} </ref><ref name="pmid11051295">{{cite journal| author=Gottfredsson M, Perfect JR| title=Fungal meningitis. | journal=Semin Neurol | year= 2000 | volume= 20 | issue= 3 | pages= 307-22 | pmid=11051295 | doi=10.1055/s-2000-9394 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11051295  }} </ref><ref name="pmid16291364">{{cite journal| author=Banarer M, Cost K, Rychwalski P, Bryant KA| title=Chronic lymphocytic meningitis in an adolescent. | journal=J Pediatr | year= 2005 | volume= 147 | issue= 5 | pages= 686-90 | pmid=16291364 | doi=10.1016/j.jpeds.2005.07.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16291364  }} </ref>
Analysis of the [[CSF]] in suspected [[fungal meningitis]] should include:<ref name="pmid1569350">{{cite journal| author=White M, Cirrincione C, Blevins A, Armstrong D| title=Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease. | journal=J Infect Dis | year= 1992 | volume= 165 | issue= 5 | pages= 960-3 | pmid=1569350 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1569350  }} </ref><ref name="pmid23083311">{{cite journal| author=Pettit AC, Kropski JA, Castilho JL, Schmitz JE, Rauch CA, Mobley BC et al.| title=The index case for the fungal meningitis outbreak in the United States. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 22 | pages= 2119-25 | pmid=23083311 | doi=10.1056/NEJMoa1212292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23083311  }} </ref><ref name="pmid11051295">{{cite journal| author=Gottfredsson M, Perfect JR| title=Fungal meningitis. | journal=Semin Neurol | year= 2000 | volume= 20 | issue= 3 | pages= 307-22 | pmid=11051295 | doi=10.1055/s-2000-9394 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11051295  }} </ref><ref name="pmid16291364">{{cite journal| author=Banarer M, Cost K, Rychwalski P, Bryant KA| title=Chronic lymphocytic meningitis in an adolescent. | journal=J Pediatr | year= 2005 | volume= 147 | issue= 5 | pages= 686-90 | pmid=16291364 | doi=10.1016/j.jpeds.2005.07.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16291364  }} </ref>
*Opening pressure measurement  
*Opening pressure measurement  
This has prognostic and therapeutic value especially in cryptococcal meningitis although it is not commonly done or recorded.
This has prognostic and therapeutic value especially in cryptococcal meningitis although it is not commonly done or recorded.
*Cell count with differential,  
*Cell count with differential,  
Most patients have mononuclear pleocytosis in the range of 20 to 500 cells/mm3 however some patients have polymorphonuclear neutrophils as the predominant cell type in caese os aspergillosis and  
Most patients have mononuclear [[pleocytosis]] in the range of 20 to 500 cells/mm3 however some patients have polymorphonuclear neutrophils as the predominant cell type in caese os aspergillosis and  
eosinophilia when Cryptococcus immitis is suspected<ref name="pmid1569350">{{cite journal| author=White M, Cirrincione C, Blevins A, Armstrong D| title=Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease. | journal=J Infect Dis | year= 1992 | volume= 165 | issue= 5 | pages= 960-3 | pmid=1569350 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1569350  }} </ref><ref name="pmid23083311">{{cite journal| author=Pettit AC, Kropski JA, Castilho JL, Schmitz JE, Rauch CA, Mobley BC et al.| title=The index case for the fungal meningitis outbreak in the United States. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 22 | pages= 2119-25 | pmid=23083311 | doi=10.1056/NEJMoa1212292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23083311  }} </ref>
[[eosinophilia]] when [[Cryptococcus]] immitis is suspected<ref name="pmid1569350">{{cite journal| author=White M, Cirrincione C, Blevins A, Armstrong D| title=Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease. | journal=J Infect Dis | year= 1992 | volume= 165 | issue= 5 | pages= 960-3 | pmid=1569350 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1569350  }} </ref><ref name="pmid23083311">{{cite journal| author=Pettit AC, Kropski JA, Castilho JL, Schmitz JE, Rauch CA, Mobley BC et al.| title=The index case for the fungal meningitis outbreak in the United States. | journal=N Engl J Med | year= 2012 | volume= 367 | issue= 22 | pages= 2119-25 | pmid=23083311 | doi=10.1056/NEJMoa1212292 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23083311  }} </ref>
In patients who are immunosuppressed, the cell count may be markedly decreased to less than 20 cells/mm3.
In patients who are immunosuppressed, the cell count may be markedly decreased to less than 20 cells/mm3.
*Glucose concentration
*Glucose concentration
Line 26: Line 26:
===Other CSF Findings and Serology Tests Specific to Each Particular Fungi===
===Other CSF Findings and Serology Tests Specific to Each Particular Fungi===
*''[[Aspergillus]] spp.''
*''[[Aspergillus]] spp.''
**CSF culture may grow Aspergillus fumigatus complex or may be sterile<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>
**CSF culture may grow [[Aspergillus fumigatus]] complex or may be sterile<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>
**Gomori-Grocott staining may reveale hyaline septate hyphae<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>   
**Gomori-Grocott staining may reveale hyaline septate hyphae<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>   
**Baseline serum and CSF 1,3-β-d-glucan (BDG) measurements  are positive whereas serum and CSF galactomannan (GM) antigen test results are negative in an ''Aspergillus fumigatus''-specific PCR assay.<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>
**Baseline serum and [[CSF]] 1,3-β-d-[[glucan]] (BDG) measurements  are positive whereas serum and [[CSF]] [[galactomannan]] (GM) antigen test results are negative in an ''[[Aspergillus fumigatus]]''-specific [[PCR]] assay.<ref name="pmid26392507">{{cite journal| author=Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R et al.| title=Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole. | journal=Antimicrob Agents Chemother | year= 2015 | volume= 59 | issue= 12 | pages= 7857-61 | pmid=26392507 | doi=10.1128/AAC.01506-15 | pmc=4649149 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26392507  }} </ref>
*''[[Blastomyces dermatitidis]]''
*''[[Blastomyces dermatitidis]]''
**Fungal stain and culture of CSF
**Fungal stain and culture of CSF
Line 34: Line 34:
**Antibody detection in serum
**Antibody detection in serum
*''[[Cryptococcus neoformans]]''
*''[[Cryptococcus neoformans]]''
**India ink or fungal wet mount of CSF (budding yeast)
**India ink or fungal wet mount of [[CSF]] (budding yeast)
**Mucicarmine stain provides specific staining of the polysaccharide cell wall
**[[Mucicarmine]] stain provides specific staining of the polysaccharide cell wall
**Blood and urine cultures
**Blood and urine cultures
**Antigen detection in CSF
**Antigen detection in [[CSF]]
*''[[Coccidioides immitis]]''
*''[[Coccidioides immitis]]''
**Antibody detection in CSF and serum
**Antibody detection in [[CSF]] and serum
*''[[Candida sp.]]''
*''[[Candida sp.]]''
**Fungal stain and culture of CSF
**Fungal stain and culture of [[CSF]]
*''[[Histoplasma capsulatum]]''
*''[[Histoplasma capsulatum]]''
**Fungal stain and culture of large volumes of CSF
**Fungal stain and culture of large volumes of [[CSF]]
**Antigen detection in CSF, serum, and urine
**Antigen detection in [[CSF]], serum, and urine
**Antibody detection in serum and CSF
**Antibody detection in serum and [[CSF]]
*''[[Sporothrix schenckii]]''
*''[[Sporothrix schenckii]]''
**Antibody detection in CSF and serum
**Antibody detection in [[CSF]] and serum
**CSF culture<ref>Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J,  eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.</ref>
**[[CSF]] culture<ref>Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J,  eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.</ref>


Laboratory findings differentiating fungal meningitis from other causes of meningitis by cerebrospinal fluid examination:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref>
Laboratory findings differentiating [[fungal meningitis]] from other causes of meningitis by [[cerebrospinal fluid]] examination:<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798  }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618  }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096  }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948  }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+  
|+  

Revision as of 23:15, 14 February 2017

Meningitis main page

Fungal meningitis Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Fungal meningitis from other Diseases

Epidemiology and Demographics

Screening

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

ECG

MRI

CT

Ultrasound

Other Imaging Findings

Other Diagnostic Findings

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Fungal meningitis laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Fungal meningitis laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Fungal meningitis laboratory findings

CDC on Fungal meningitis laboratory findings

Fungal meningitis laboratory findings in the news

Blogs on Fungal meningitis laboratory findings

Directions to Hospitals Treating Fungal meningitis

Risk calculators and risk factors for Fungal meningitis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby; Prince Tano Djan, BSc, MBChB [2]

Overview

A lumbar puncture is essential for the diagnosis of fungal meningitis and initiation of the appropriate treatment. The cerebrospinal fluid (CSF) of a patient having fungal meningitis is distinguished by the presence of lymphocytosis, low glucose level and high proteins level. Specific CSF stains and cultures as well as serologies help in determining the specific nature of the causative fungi. Biopsy of skin lesions, chest radiography, ophthalmologic examination, computed tomography or MRI of the brain, in addition to cultures of CSF, blood, and sputum, may provide essential diagnostic clues.

Laboratory Findings

The General Characteristic CSF Findings in Fungal Meningitis:

Analysis of the CSF in suspected fungal meningitis should include:[1][2][3][4]

  • Opening pressure measurement

This has prognostic and therapeutic value especially in cryptococcal meningitis although it is not commonly done or recorded.

  • Cell count with differential,

Most patients have mononuclear pleocytosis in the range of 20 to 500 cells/mm3 however some patients have polymorphonuclear neutrophils as the predominant cell type in caese os aspergillosis and eosinophilia when Cryptococcus immitis is suspected[1][2] In patients who are immunosuppressed, the cell count may be markedly decreased to less than 20 cells/mm3.

  • Glucose concentration

Glucose concentrations are usually decreased by may vary depending on the clinical state of the patient.

  • Protein concentrations

CSF protein levels are usually increased

  • Gram’s stain,
  • India ink,
  • Culture.

Other CSF Findings and Serology Tests Specific to Each Particular Fungi

Laboratory findings differentiating fungal meningitis from other causes of meningitis by cerebrospinal fluid examination:[7][8][9][10][11]

Cerebrospinal fluid level Normal level Bacterial meningitis[10] Viral meningitis[10] Fungal meningitis Tuberculous meningitis[12] Malignant meningitis[7]
Cells/ul < 5 >300 10-1000 10-500 50-500 >4
Cells Lymphos:Monos 7:3 Gran. > Lymph Lymph. > Gran. Lympho.>Gran Lymphocytes Lymphocytes
Total protein (mg/dl) 45-60 Typically 100-500 Normal or slightly high High Typically 100-200 >50
Glucose ratio (CSF/plasma)[8] > 0.5 < 0.3 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[9] < 2.1 > 2.1 < 2.1 >3.2 > 2.1 >2.1
Others ICP:6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen PCR of HSV-DNA, VZV CSF gram stain, CSF india ink PCR of TBC-DNA CSF tumour markers such as alpha fetoproteins, CEA

Fungal Stains

  • Blastomyces: Broad based budding

    Blastomyces: Broad based budding

  • Cryptococcus: clear halo visualized by the india ink stain

    Cryptococcus: clear halo visualized by the india ink stain

  • Histoplama capsulatum

    Histoplama capsulatum


Cryptococcosis (PAS stain)

{{#ev:youtube|ZG0AcmtBLe4}}

References

  1. ↑ 1.0 1.1 White M, Cirrincione C, Blevins A, Armstrong D (1992). "Cryptococcal meningitis: outcome in patients with AIDS and patients with neoplastic disease". J Infect Dis. 165 (5): 960–3. PMID 1569350.
  2. ↑ 2.0 2.1 Pettit AC, Kropski JA, Castilho JL, Schmitz JE, Rauch CA, Mobley BC; et al. (2012). "The index case for the fungal meningitis outbreak in the United States". N Engl J Med. 367 (22): 2119–25. doi:10.1056/NEJMoa1212292. PMID 23083311.
  3. ↑ Gottfredsson M, Perfect JR (2000). "Fungal meningitis". Semin Neurol. 20 (3): 307–22. doi:10.1055/s-2000-9394. PMID 11051295.
  4. ↑ Banarer M, Cost K, Rychwalski P, Bryant KA (2005). "Chronic lymphocytic meningitis in an adolescent". J Pediatr. 147 (5): 686–90. doi:10.1016/j.jpeds.2005.07.010. PMID 16291364.
  5. ↑ 5.0 5.1 5.2 Morgand M, Rammaert B, Poirée S, Bougnoux ME, Tran H, Kania R; et al. (2015). "Chronic Invasive Aspergillus Sinusitis and Otitis with Meningeal Extension Successfully Treated with Voriconazole". Antimicrob Agents Chemother. 59 (12): 7857–61. doi:10.1128/AAC.01506-15. PMC 4649149. PMID 26392507.
  6. ↑ Koroshetz WJ. Chapter 382. Chronic and Recurrent Meningitis. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York: McGraw-Hill; 2012.
  7. ↑ 7.0 7.1 Le Rhun E, Taillibert S, Chamberlain MC (2013). "Carcinomatous meningitis: Leptomeningeal metastases in solid tumors". Surg Neurol Int. 4 (Suppl 4): S265–88. doi:10.4103/2152-7806.111304. PMC 3656567. PMID 23717798.
  8. ↑ 8.0 8.1 Chow E, Troy SB (2014). "The differential diagnosis of hypoglycorrhachia in adult patients". Am J Med Sci. 348 (3): 186–90. doi:10.1097/MAJ.0000000000000217. PMC 4065645. PMID 24326618.
  9. ↑ 9.0 9.1 Leen WG, Willemsen MA, Wevers RA, Verbeek MM (2012). "Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice". PLoS One. 7 (8): e42745. doi:10.1371/journal.pone.0042745. PMC 3412827. PMID 22880096.
  10. ↑ 10.0 10.1 10.2 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
  11. ↑ Brouwer MC, Tunkel AR, van de Beek D (2010). "Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis". Clin Microbiol Rev. 23 (3): 467–92. doi:10.1128/CMR.00070-09. PMC 2901656. PMID 20610819.
  12. ↑ Caudie C, Tholance Y, Quadrio I, Peysson S (2010). "[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]". Ann Biol Clin (Paris). 68 (1): 107–11. doi:10.1684/abc.2010.0407. PMID 20146981.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Fungal_meningitis_laboratory_findings&oldid=1293616"