Bacterial meningitis laboratory findings: Difference between revisions

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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="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral 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="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}<ref name="pmid20146981">{{cite journal| author=Caudie C, Tholance Y, Quadrio I, Peysson S| title=[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. | journal=Ann Biol Clin (Paris) | year= 2010 | volume= 68 | issue= 1 | pages= 107-11 | pmid=20146981 | doi=10.1684/abc.2010.0407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20146981  }} </ref>
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Malignant meningitis}}<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>
|-
| 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: #F5F5F5;" |'''10-1000'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''10-500'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''50-500'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>4'''
|-
| 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: #F5F5F5;" |'''Lymph. > Gran.'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Lympho.>Gran'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Lymphocytes'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Lymphocytes'''
|-
| 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: #F5F5F5;" | '''Normal or slightly high'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''High'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-200'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>50'''
|-
| 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: #F5F5F5;" |'''> 0.6'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.3'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.5'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5'''
|-
| 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: #F5F5F5;" |'''< 2.1'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''>3.2'''
| 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'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''PCR of HSV-DNA, VZV'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF gram stain, CSF india ink'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''PCR of TBC-DNA'''
| style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as alpha fetoproteins, CEA'''
|-
|}


==References==
==References==

Revision as of 16:38, 12 January 2017

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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

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
  • Elevated or decreased leukocyte count(severe infection) with a left shift[4]
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[6] Viral meningitis[6] Fungal meningitis Tuberculous meningitis[7] Malignant meningitis[8]
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)[9] > 0.5 < 0.3 > 0.6 <0.3 < 0.5 <0.5
Lactate (mmols/l)[10] < 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

References

  1. ↑ 1.0 1.1 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 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. ↑ 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 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.
  5. ↑ 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.
  6. ↑ 6.0 6.1 Negrini B, Kelleher KJ, Wald ER (2000). "Cerebrospinal fluid findings in aseptic versus bacterial meningitis". Pediatrics. 105 (2): 316–9. PMID 10654948.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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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