Profile of Cerebrospinal Fluid Analysis in Acute Central Nervous System Infections

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Profile of Cerebrospinal Fluid Analysis in Acute Central Nervous System Infections

Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 1

Abstract

Background: Confirmatory diagnosis of acute central nervous system (CNS) infection is a concern. Most often, it is presumed and empirical antimicrobials given. CSF findings may overlap in various infections and partially treated meningitis further complicates the CSF analysis. Materials and Methods: This study included 90 patients with acute CNS infection admitted between July 2009 and August 2011. Ninety cases of community-acquired CNS infection were included in the study. The diagnosis of CNS infection was made based on the clinical features. Laboratory investigations such as complete blood count, random blood sugar, urine analysis, renal and liver function tests, and serum electrolytes were done in all cases. Cerebrospinal fluid (CSF) samples were collected and sent for cell count, glucose, protein, chloride, Gram stain, bacterial culture, AFB smear, culture of AFB, and viral markers like herpes simplex virus (HSV). Results: 15 patients (16.7%) had bacterial meningitis, 32 (35.5%) had tuberculous (TB) meningitis, 9 (10%) had aseptic meningitis, 30 (33.3%) had encephalitis, and 4 (4.5%) had cryptococcal meningitis. The CSF sugar-to-blood sugar ratio was found to be <0.5 in 71.1% of all CNS infections. 93.3% of bacterial meningitis, 100% of TB meningitis, and 100% of cryptococcal meningitis had a CSF-to-blood sugar ratio <0.5 while only 33.3% of aseptic meningitis and 40% of encephalitis had such a value. TB meningitis had the maximum mean CSF protein of 275 followed by cryptococcal meningitis - 169. The mean CSF total count was found to be 257 for all CNS infections together. It was found to be maximum 559 for bacterial meningitis. Gram-positive cocci were reported in five patients and Gram-negative coccobacilli were reported in one patient. Polymerase chain reaction (PCR) for TB was positive in 10 (31.2%) patients with TB meningitis. PCR for HSV was positive in 8 (20.5%) patients with aseptic meningitis or encephalitis. IgM HSV was positive in 16 (41%) patients with aseptic meningitis or encephalitis. Conclusion: Routine CSF cell count and biochemical analysis are of prime importance in differentiating between CNS infections and identifying individual CNS infections. PCR was not found to be useful in the diagnosis.

Authors and Affiliations

K Vasanthan, Yeldho Verghese, R B Sudagar Singh, J Damodharan

Keywords

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EP ID EP478524
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