Bacterial meningitis laboratory findings: Difference between revisions

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==Overview==
==Overview==
Labortary findings of bacterial meningitis may include non specific and specific tests. Non specific findings include CBC, biochemical profile, coagulation profile and blood culture. Specific tests for bacterial meningitis include CSF analysis, CSF gram stain and culture.<ref name="pmid6763303">{{cite journal| author=Geiseler PJ, Nelson KE, Levin S, Reddi KT, Moses VK| title=Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976. | journal=Rev Infect Dis | year= 1980 | volume= 2 | issue= 5 | pages= 725-45 | pmid=6763303 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6763303  }} </ref><ref name="pmid3287565">{{cite journal| author=Talan DA, Hoffman JR, Yoshikawa TT, Overturf GD| title=Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art. | journal=Rev Infect Dis | year= 1988 | volume= 10 | issue= 2 | pages= 365-76 | pmid=3287565 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3287565  }} </ref><ref name="pmid11694698">{{cite journal| author=Kanegaye JT, Soliemanzadeh P, Bradley JS| title=Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment. | journal=Pediatrics | year= 2001 | volume= 108 | issue= 5 | pages= 1169-74 | pmid=11694698 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11694698  }} </ref><ref name=cde>https://www.cdc.gov/meningitis/lab-manual/chpt06-culture-id.html Accessed on Jan 12, 2017</ref><ref name="pmid24510292">{{cite journal| author=Jones GS, D'Orazio SE| title=Listeria monocytogenes: cultivation and laboratory maintenance. | journal=Curr Protoc Microbiol | year= 2013 | volume= 31 | issue=  | pages= 9B.2.1-7 | pmid=24510292 | doi=10.1002/9780471729259.mc09b02s31 | pmc=3920655 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24510292  }} </ref>
==Lab findings==
==Lab findings==
Labortary tests which may help identify the bacterial meningitis include non specific tests and specific diagnostic tests.  
Labortary tests which may help identify the bacterial meningitis include non specific tests and specific diagnostic tests.  
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| style="background: #DCDCDC; padding: 5px;"|  
*Elevated or decreased [[leukocyte]] count(severe infection) with a left shift<ref name="pmid10470556">{{cite journal| author=Kaplan SL| title=Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. | journal=Infect Dis Clin North Am | year= 1999 | volume= 13 | issue= 3 | pages= 579-94, vi-vii | pmid=10470556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10470556  }} </ref>
*Elevated or decreased [[leukocyte]] count(severe infection) with a left shift<ref name="pmid10470556">{{cite journal| author=Kaplan SL| title=Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. | journal=Infect Dis Clin North Am | year= 1999 | volume= 13 | issue= 3 | pages= 579-94, vi-vii | pmid=10470556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10470556  }} </ref>
*To detect [[meningococcus|meningococcal]] [[septicemia]], routine assessment of the [[neutrophil]] counts must be considered, as follows:<ref name="pmid23736141">{{cite journal| author=Demissie DE, Kaplan SL, Romero JR, Leake JA, Barson WJ, Halasa NB et al.| title=Altered neutrophil counts at diagnosis of invasive meningococcal infection in children. | journal=Pediatr Infect Dis J | year= 2013 | volume= 32 | issue= 10 | pages= 1070-2 | pmid=23736141 | doi=10.1097/INF.0b013e31829e31f1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23736141  }} </ref>
**Absolute [[Neutrophil]] Count (ANC): ≤1000/mm or ≥10,000/mm
**Immature [[Neutrophil]] Count (INC): ≥500/mm
**Immature-to-Total [[Neutrophil]] Ratio (ITR): ≥0.20
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Biochemistry]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Biochemistry]]'''
| style="background: #DCDCDC; padding: 5px;"|  
| style="background: #DCDCDC; padding: 5px;"|  
*[[Hypoglycemia]]<br>Elevated [[creatinine]]<br>
*[[Hypoglycemia]]<br>
*Elevated [[creatinine]]<br>
*Elevated [[ALT]], [[AST]]<br>
*Elevated [[ALT]], [[AST]]<br>
*Possible [[hyponatremia]]<ref name="pmid17178734">{{cite journal| author=Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J| title=Hyponatraemia in adults with community-acquired bacterial meningitis. | journal=QJM | year= 2007 | volume= 100 | issue= 1 | pages= 37-40 | pmid=17178734 | doi=10.1093/qjmed/hcl131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17178734  }} </ref><br>
*Possible [[hyponatremia]]<ref name="pmid17178734">{{cite journal| author=Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J| title=Hyponatraemia in adults with community-acquired bacterial meningitis. | journal=QJM | year= 2007 | volume= 100 | issue= 1 | pages= 37-40 | pmid=17178734 | doi=10.1093/qjmed/hcl131 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17178734  }} </ref><br>
*Acidosis: High [[lactate]]; Low [[bicarbonate]] (shock)
*Acidosis: High [[lactate]];  
*Low [[bicarbonate]] (shock)
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Coagulation]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Coagulation]]'''
| style="background: #DCDCDC; padding: 5px;"|  
| style="background: #DCDCDC; padding: 5px;"|  
*[[Thrombocytopenia]]-poor prognosis<ref name="pmid10470556">{{cite journal| author=Kaplan SL| title=Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. | journal=Infect Dis Clin North Am | year= 1999 | volume= 13 | issue= 3 | pages= 579-94, vi-vii | pmid=10470556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10470556  }} </ref>
*[[Thrombocytopenia]]-poor prognosis<ref name="pmid10470556">{{cite journal| author=Kaplan SL| title=Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis. | journal=Infect Dis Clin North Am | year= 1999 | volume= 13 | issue= 3 | pages= 579-94, vi-vii | pmid=10470556 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10470556  }} </ref>
* Increased D-Dimers, increased PT/APTT-[[DIC]]
*Increased D-Dimers,  
*Increased PT/APTT-[[DIC]]
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Blood culture]]'''
| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Blood culture]]'''
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===Specific tests===
===Specific tests===
Specific diagnostic tests include lumbar puncture with CSF examination and CSF culture.
Specific diagnostic tests include [[lumbar puncture]] with CSF examination and CSF culture. CSF examination findings in bacterial meningitis are as follows:
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Normal level}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}<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>
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Cells/ul'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>300'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Cells'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Lymphos:Monos 7:3'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Gran. > Lymph'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Total protein (mg/dl''')
| style="padding: 5px 5px; background: #F5F5F5;" |'''45-60'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-500'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)<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>'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.3'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)<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>'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Others'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''ICP:6-12 (cm H2O)'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF gram stain, CSF culture, CSF bacterial antigen'''
|-
|}
 
=== CSF gram stain and culture: ===
CSF gram stain findings include the following:<ref name=cde>https://www.cdc.gov/meningitis/lab-manual/chpt06-culture-id.html Accessed on Jan 12, 2017</ref><ref name="pmid24510292">{{cite journal| author=Jones GS, D'Orazio SE| title=Listeria monocytogenes: cultivation and laboratory maintenance. | journal=Curr Protoc Microbiol | year= 2013 | volume= 31 | issue=  | pages= 9B.2.1-7 | pmid=24510292 | doi=10.1002/9780471729259.mc09b02s31 | pmc=3920655 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24510292  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA; width: 150px;" |{{fontcolor|#FFF|CSF Gram Stain Finding}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|Causative Organism}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|Culture medium}}
! style="background: #4479BA; width: 250px;" |{{fontcolor|#FFF|Growth on culture medium}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Gram positive diplococcus
| style="padding: 5px 5px; background: #F5F5F5;" |[[Streptococcus Group A|Streptococcus Pneumonia]]
| style="padding: 5px 5px; background: #DCDCDC;" |Blood agar plate
| style="padding: 5px 5px; background: #F5F5F5;" |Small, grey, moist (sometimes mucoidal), watery colonies
with green zone of allpha hemolysis
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Gram negative [[diplococcus]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Neisseria Meningitidis|Neisseria Meningitides]]
| style="padding: 5px 5px; background: #DCDCDC;" |Blood agar plate and chocolate agar plate
| style="padding: 5px 5px; background: #F5F5F5;" |Round, smooth, moist, glistening, and convex
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Gram positive [[coccobacillus]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Listeria monocytogenes|Listeria Monocytogenes]]
| style="padding: 5px 5px; background: #DCDCDC;" |Brain heart infusion
| style="padding: 5px 5px; background: #F5F5F5;" |Isolated small 1mm colonies creamy white in colour and dome shaped
|-
| style="padding: 5px 5px; background: #DCDCDC;" |Small [[pleomorphic]] gram - negative coccobacilli
| style="padding: 5px 5px; background: #F5F5F5;" |[[Haemophilus Influenzae B|Haemophilus Influenzae]]
| style="padding: 5px 5px; background: #DCDCDC;" |Chocolate agar plate enriched with NAD and hematin (X)
| style="padding: 5px 5px; background: #F5F5F5;" |Large, colorless-to-grey, opaque colonies
|-
|}


==References==
==References==
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Latest revision as of 20:34, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

Labortary findings of bacterial meningitis may include non specific and specific tests. Non specific findings include CBC, biochemical profile, coagulation profile and blood culture. Specific tests for bacterial meningitis include CSF analysis, CSF gram stain and culture.[1][2][3][4][5]

Lab findings

Labortary tests which may help identify the bacterial meningitis include non specific tests and specific diagnostic tests.

Non specific tests

Non specific tests include blood tests such as complete blood count, liver function tests, renal function tests, biochemistry, and coagulation profile.[1][2][3]

Laboratory findings
Test Findings
Complete blood count
White blood cell count
Biochemistry
Coagulation
Blood culture
  • Positive in 50 to 90 percent of patients [1][2]
  • Two sets of blood cultures needed before antimicrobials

Specific tests

Specific diagnostic tests include lumbar puncture with CSF examination and CSF culture. CSF examination findings in bacterial meningitis are as follows:

Cerebrospinal fluid level Normal level Bacterial meningitis[9]
Cells/ul < 5 >300
Cells Lymphos:Monos 7:3 Gran. > Lymph
Total protein (mg/dl) 45-60 Typically 100-500
Glucose ratio (CSF/plasma)[10] > 0.5 < 0.3
Lactate (mmols/l)[11] < 2.1 > 2.1
Others ICP:6-12 (cm H2O) CSF gram stain, CSF culture, CSF bacterial antigen

CSF gram stain and culture:

CSF gram stain findings include the following:[4][5]

CSF Gram Stain Finding Causative Organism Culture medium Growth on culture medium
Gram positive diplococcus Streptococcus Pneumonia Blood agar plate Small, grey, moist (sometimes mucoidal), watery colonies

with green zone of allpha hemolysis

Gram negative diplococcus Neisseria Meningitides Blood agar plate and chocolate agar plate Round, smooth, moist, glistening, and convex
Gram positive coccobacillus Listeria Monocytogenes Brain heart infusion Isolated small 1mm colonies creamy white in colour and dome shaped
Small pleomorphic gram - negative coccobacilli Haemophilus Influenzae Chocolate agar plate enriched with NAD and hematin (X) Large, colorless-to-grey, opaque colonies

References

  1. ↑ 1.0 1.1 1.2 Geiseler PJ, Nelson KE, Levin S, Reddi KT, Moses VK (1980). "Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976". Rev Infect Dis. 2 (5): 725–45. PMID 6763303.
  2. ↑ 2.0 2.1 2.2 Talan DA, Hoffman JR, Yoshikawa TT, Overturf GD (1988). "Role of empiric parenteral antibiotics prior to lumbar puncture in suspected bacterial meningitis: state of the art". Rev Infect Dis. 10 (2): 365–76. PMID 3287565.
  3. ↑ 3.0 3.1 Kanegaye JT, Soliemanzadeh P, Bradley JS (2001). "Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment". Pediatrics. 108 (5): 1169–74. PMID 11694698.
  4. ↑ 4.0 4.1 https://www.cdc.gov/meningitis/lab-manual/chpt06-culture-id.html Accessed on Jan 12, 2017
  5. ↑ 5.0 5.1 Jones GS, D'Orazio SE (2013). "Listeria monocytogenes: cultivation and laboratory maintenance". Curr Protoc Microbiol. 31: 9B.2.1-7. doi:10.1002/9780471729259.mc09b02s31. PMC 3920655. PMID 24510292.
  6. ↑ 6.0 6.1 Kaplan SL (1999). "Clinical presentations, diagnosis, and prognostic factors of bacterial meningitis". Infect Dis Clin North Am. 13 (3): 579–94, vi–vii. PMID 10470556.
  7. ↑ Demissie DE, Kaplan SL, Romero JR, Leake JA, Barson WJ, Halasa NB; et al. (2013). "Altered neutrophil counts at diagnosis of invasive meningococcal infection in children". Pediatr Infect Dis J. 32 (10): 1070–2. doi:10.1097/INF.0b013e31829e31f1. PMID 23736141.
  8. ↑ Brouwer MC, van de Beek D, Heckenberg SG, Spanjaard L, de Gans J (2007). "Hyponatraemia in adults with community-acquired bacterial meningitis". QJM. 100 (1): 37–40. doi:10.1093/qjmed/hcl131. PMID 17178734.
  9. ↑ Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
  10. ↑ 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.
  11. ↑ 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.


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