Bacterial meningitis lumbar puncture: Difference between revisions

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===Findings of lumbar puncture in bacterial meningitis===
===Findings of lumbar puncture in bacterial meningitis===
Following CSF findings may suggest bacterial meningitis:<ref name="pmid12432041">{{cite journal| author=de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators| title=Dexamethasone in adults with bacterial meningitis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 20 | pages= 1549-56 | pmid=12432041 | doi=10.1056/NEJMoa021334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432041  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725615 Review in: ACP J Club. 2003 May-Jun;138(3):60] </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref>
Following CSF findings may suggest bacterial meningitis:<ref name="pmid12432041">{{cite journal| author=de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators| title=Dexamethasone in adults with bacterial meningitis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 20 | pages= 1549-56 | pmid=12432041 | doi=10.1056/NEJMoa021334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432041  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725615 Review in: ACP J Club. 2003 May-Jun;138(3):60] </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref>
*A pressure of over 180 mmH2O <ref name="pmid12432041">{{cite journal| author=de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators| title=Dexamethasone in adults with bacterial meningitis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 20 | pages= 1549-56 | pmid=12432041 | doi=10.1056/NEJMoa021334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432041  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725615 Review in: ACP J Club. 2003 May-Jun;138(3):60] </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref><ref name="pmid21194480">{{cite journal| author=Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K| title=Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. | journal=Crit Care | year= 2010 | volume= 14 | issue= 6 | pages= R240 | pmid=21194480 | doi=10.1186/cc9395 | pmc=3220013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21194480  }} </ref>
*A pressure of over 180 mmH2O <ref name="pmid12432041">{{cite journal| author=de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators| title=Dexamethasone in adults with bacterial meningitis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 20 | pages= 1549-56 | pmid=12432041 | doi=10.1056/NEJMoa021334 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432041  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725615 Review in: ACP J Club. 2003 May-Jun;138(3):60] </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref><ref name="pmid21194480">{{cite journal| author=Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K| title=Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. | journal=Crit Care | year= 2010 | volume= 14 | issue= 6 | pages= R240 | pmid=21194480 | doi=10.1186/cc9395 | pmc=3220013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21194480 }} </ref><ref name="pmid21382412">{{cite journal| author=Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S| title=Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. | journal=J Infect | year= 2011 | volume= 62 | issue= 4 | pages= 255-62 | pmid=21382412 | doi=10.1016/j.jinf.2011.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382412  }} </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268 }} </ref>
*CSF cell count in 1000s.  
*CSF cell count in 1000s<ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268  }} </ref>
*Granulocytes > lymphocytest
*Granulocytes > lymphocytes
*Elevated protein may range between 100-500mg/dl
*Elevated protein may range between 100-500mg/dl
*Glucose ratio(CSF/plasma)<0.3
*Glucose ratio(CSF/plasma)<0.3
*CSF lactate >2.1mmol/l<ref name="pmid21194480">{{cite journal| author=Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K| title=Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. | journal=Crit Care | year= 2010 | volume= 14 | issue= 6 | pages= R240 | pmid=21194480 | doi=10.1186/cc9395 | pmc=3220013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21194480  }} </ref>
*CSF lactate >2.1mmol/l<ref name="pmid21194480">{{cite journal| author=Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K| title=Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis. | journal=Crit Care | year= 2010 | volume= 14 | issue= 6 | pages= R240 | pmid=21194480 | doi=10.1186/cc9395 | pmc=3220013 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21194480  }} </ref><ref name="pmid21382412">{{cite journal| author=Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S| title=Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. | journal=J Infect | year= 2011 | volume= 62 | issue= 4 | pages= 255-62 | pmid=21382412 | doi=10.1016/j.jinf.2011.02.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21382412  }} </ref>
*CSF gram stain findings


===Contraindications of lumbar puncture===
===Contraindications of lumbar puncture===

Revision as of 19:45, 9 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

Lumbar puncture

Indications of lumbar puncture

Findings of lumbar puncture in bacterial meningitis

Following CSF findings may suggest bacterial meningitis:[1][2]

  • A pressure of over 180 mmH2O [1][2][3][4][2]
  • CSF cell count in 1000s[2]
  • Granulocytes > lymphocytes
  • Elevated protein may range between 100-500mg/dl
  • Glucose ratio(CSF/plasma)<0.3
  • CSF lactate >2.1mmol/l[3][4]
  • CSF gram stain findings

Contraindications of lumbar puncture

References

  1. ↑ 1.0 1.1 de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
  2. ↑ 2.0 2.1 2.2 2.3 Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS; et al. (1993). "Acute bacterial meningitis in adults. A review of 493 episodes". N Engl J Med. 328 (1): 21–8. doi:10.1056/NEJM199301073280104. PMID 8416268.
  3. ↑ 3.0 3.1 Huy NT, Thao NT, Diep DT, Kikuchi M, Zamora J, Hirayama K (2010). "Cerebrospinal fluid lactate concentration to distinguish bacterial from aseptic meningitis: a systemic review and meta-analysis". Crit Care. 14 (6): R240. doi:10.1186/cc9395. PMC 3220013. PMID 21194480.
  4. ↑ 4.0 4.1 Sakushima K, Hayashino Y, Kawaguchi T, Jackson JL, Fukuhara S (2011). "Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis". J Infect. 62 (4): 255–62. doi:10.1016/j.jinf.2011.02.010. PMID 21382412.


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