Meningococcemia laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Laboratory Findings

Blood tests will be done to rule out other infections and help confirm meningococcemia. Such tests may include:

• Blood culture
• Complete blood count with differential
• Clotting studies (PT, PTT)

Other tests that may be done include:

• Lumbar puncture to obtain spinal fluid sample for CSF culture
• Skin biopsy and gram stain
• Urinalysis

Electrolyte and Biomarker Studies

• Blood cultures were positive in 41.4% of 400 cultures in one series of patients with meningococcal disease.
• Cerebrospinal fluid (CSF) culture and gram stain were positive in 94% of patients in the same series.
• The ability to culture the meningococcus from CSF will not be substantially reduced if the cultures are obtained within one hour of antibiotic administration.
• One series revealed a median leukocyte count of approximately 1200 in CSF (range 10 to 65,000/mm). Approximately 75% had a CSF glucose level less than 40 mg/100 mL. CSF protein ranged from 25 to over 800 mg/100 mL with a median value of 150 mg/100 mL.
• Polymerase chain reaction (PCR) has been shown in a study with 54 samples to be 91% sensitive and specific, particularly useful when cultures may be negative due to prior antibiotic administration.
• Latex agglutination can detect A, B, C, Y, and W-135 though the sensitivity of detecting serogroup B is low.

HUSSEIN AND SHAFRAN CANADIAN REVIEW OF BACTERIAL MENINGITIS

Cloudy CSF	78%
CSF >= 1000 WBC/mm3	56%
CSF >= 10,000 WBC/mm3	14%
CSF Neutrophil predominance	90%
CSF Glucose =< 50 mg/deL	70%
CSF Protein > 200 mg/dL	66%
Gram Stain without bacteria	53%
Gram Stain Neg --> Culture Pos	47%

References

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