Ali Hassan Abro, Ahmed Saleh Abdou, Hakim Ali, Abdulla Mahmood Ustadi, Aly Abdel Halim Hasab.
Cerebrospinal fluid analysis acute bacterial versus viral meningitis.
Pak J Med Sci Jan ;24(4):645-50.

Objective: To evaluate the cerebrospinal fluid changes in acute bacterial and viral meningitis and the role of the CSF differential in discriminating bacterial and viral meningitis in adult patients. Methodology: It is an observational study, conducted at the infectious diseases Unit, Rashid hospital Dubai (JCI accredited), United Arab Emirates, from Jan 2005 to Dec 2007. The admitted patients who fulfilled the criteria were included in the study. CT scan brain was done for almost all the patients before the lumber puncture. The CSF analysis was done on the first spinal tap and it included lactate, protein, glucose, cell count, Gram`s stain and culture. Other laboratory investigations including liver function test (LFTs), full blood count (FBC), blood sugar, blood culture, coagulation profile and urea electrolytes were also done for all the patients. Results: A total of 134(86 bacterial and 48 viral) patients fulfilled the inclusion criteria. Among the bacterial meningitis, 74.42% patients were found to be CSF Gram`s stain and/or culture positive for bacteria, whereas 25.58% were culture negative. Overall, blood culture was positive in nineteen (29.68%) and negative in forty five (70.31%) patients. In comparison to the viral, the CSF lactate, protein, cell count with predominant polymorphs as well as blood sugar and peripheral white cell count was significantly higher in the bacterial meningitis, p value <0.0001. The mean CSF lactate level in bacterial meningitis cases amounted to 14.96 ± 6.13mmol/L with high sensitivity (98.3%) and positive predictive value (73.4%), where as it was significantly lower in the viral group 2.38±0.59mmol/L. However, the CSF glucose was found to be very low in bacterial than viral meningitis, mean 26.50±21.56 vs 67.00±18.96mg/dl (p value <0.0001). The hospital stay was longer and mortality rate was also higher in bacterial than viral group, p value <0.0001. Conclusions: CSF analysis is an important diagnostic tool to differentiate acute bacterial from viral meningitis. Furthermore, when Gram stain and culture are negative, the CSF lactate can provide pertinent, rapid and reliable diagnostic information in distinguishing bacterial from viral meningitis.

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