Bacterial meningitis laboratory findings: Difference between revisions

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Revision as of 18:56, 9 January 2017

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	Decreased hemoglobin Decreased hematocrit Elevated CRP
White blood cell count	Elevated or decreased leukocyte count(severe infection) with a left shift^[4]
Biochemistry	Hypoglycemia Elevated creatinine Elevated ALT, AST Possible hyponatremia^[5] Acidosis: High lactate; Low bicarbonate (shock)
Coagulation	Thrombocytopenia-poor prognosis^[4] Increased D-Dimers, increased PT/APTT-DIC
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.

References

↑ ^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.
↑ ^2.0 ^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.
↑ 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.
↑ ^4.0 ^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.
↑ 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.

Template:WikiDoc Sources

[pmid6763303-1] 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.

[pmid3287565-2] 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.

[pmid11694698-3] 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.

[pmid10470556-4] 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.

[pmid17178734-5] 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.

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@@ Line 7: / Line 7: @@
 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.
+Non specific tests include blood tests such as complete blood count, liver function tests, renal function tests, biochemistry, and coagulation profile.<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>
 {| style="border: 2px solid #DCDCDC; font-size: 90%; width: 30%;"
 |+ '''Laboratory findings'''
@@ Line 15: / Line 16: @@
 |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Complete blood count]]'''
-| style="background: #DCDCDC; padding: 5px;"| Decreased [[hemoglobin]]<br>Decreased [[hematocrit]]<br>Elevated [[CRP]]<ref name="pmid24754384">{{cite journal| author=Cooper EC, Ratnam I, Mohebbi M, Leder K| title=Laboratory features of common causes of fever in returned travelers. | journal=J Travel Med | year= 2014 | volume= 21 | issue= 4 | pages= 235-9 | pmid=24754384 | doi=10.1111/jtm.12122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24754384  }} </ref>
+| style="background: #DCDCDC; padding: 5px;"| Decreased [[hemoglobin]]<br>Decreased [[hematocrit]]<br>Elevated [[CRP]]
 |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[White blood cell count]]'''
-| style="background: #DCDCDC; padding: 5px;"| Elevated (children) or decreased [[leukocyte]] count (adults)
+| 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>
 |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Biochemistry]]'''
-| style="background: #DCDCDC; padding: 5px;"| [[Hypoglycemia]]<br>Elevated [[creatinine]]<br>Elevated [[ALT]], [[AST]]<ref name="pmid6703825">{{cite journal| author=Klotz SA, Jorgensen JH, Buckwold FJ, Craven PC| title=Typhoid fever. An epidemic with remarkably few clinical signs and symptoms. | journal=Arch Intern Med | year= 1984 | volume= 144 | issue= 3 | pages= 533-7 | pmid=6703825 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6703825  }} </ref><ref name="pmid16274504">{{cite journal| author=Wang JL, Kao JH, Tseng SP, Teng LJ, Ho SW, Hsueh PR| title=Typhoid fever and typhoid hepatitis in Taiwan. | journal=Epidemiol Infect | year= 2005 | volume= 133 | issue= 6 | pages= 1073-9 | pmid=16274504 | doi=10.1017/S0950268805004048 | pmc=2870341 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16274504  }} </ref><br>Possible [[hyponatremia]]<br>Acidosis: High [[lactate]]; Low [[bicarbonate]] (shock)
+| style="background: #DCDCDC; padding: 5px;"| [[Hypoglycemia]]<br>Elevated [[creatinine]]<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>Acidosis: High [[lactate]]; Low [[bicarbonate]] (shock)
 |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Coagulation]]'''
-| style="background: #DCDCDC; padding: 5px;"| [[Thrombocytopenia]]<ref name="pmid24754384">{{cite journal| author=Cooper EC, Ratnam I, Mohebbi M, Leder K| title=Laboratory features of common causes of fever in returned travelers. | journal=J Travel Med | year= 2014 | volume= 21 | issue= 4 | pages= 235-9 | pmid=24754384 | doi=10.1111/jtm.12122 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24754384  }} </ref>
+| 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>
+* Increased D-Dimers, increased PT/APTT-[[DIC]]
 |-
-| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Urinalysis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;"| '''[[Blood culture]]'''
-| style="background: #DCDCDC; padding: 5px;"| [[Proteinuria]]<br>[[hemoglobinuria]] (renal failure)
+| style="background: #DCDCDC; padding: 5px;"|
+*Positive in 50 to 90 percent of patients <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>
+*Two sets of blood cultures needed before antimicrobials
 |}