Bacterial meningitis lumbar puncture
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Bacterial meningitis Microchapters |
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Diagnosis |
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Treatment |
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 is the single most specific test to confirm the diagnosis of bacterial meningitis. It is indicated in all patients with suspicion of bacterial meningitis unless there is a contraindication. The CSF findings in patients with bacterial meningitis include low glucose concentration, high protein content, increased no of granulocytes and lactate levels
Lumbar puncture
Indications of lumbar puncture
Lumbar puncture is indicated in all pateints with strong suspicion of meningitis for the following reasons:[1]
- To confirm the diagnosis
- To differentiate the different causes of meningitis
- To diagnose the specific causative agent for bacterial meningitis
- To start the appropriate treatment as early as possible to prevent complications
Findings of lumbar puncture in bacterial meningitis
Following CSF findings may suggest bacterial meningitis:[2][3]
- A pressure of over 180 mmH2O [2][3][4][5]
- CSF cell count in 1000s[3]
- Granulocytes > lymphocytes
- Elevated protein may range between 100-500mg/dl
- Glucose ratio (CSF/plasma) <0.3
- CSF lactate >2.1mmol/l[4][5]
- CSF gram stain findings
- Gram positive diplococcus - Streptococcus Pneumonia
- Gram negative diplococcus - Neisseria Meningitides
- Gram positive coccobacillus - Listeria Monocytogenes
- Small pleomorphic gram - negative coccobacilli - Haemophilus Influenzae
Contraindications of lumbar puncture
Contraindications of lumbar puncture may include the following:[6][1]
- Increased intracranial pressure
- Mass lesion such as tumour
- Thrombocytopenia
- Bleeding diathesis
References
- ↑ 1.0 1.1 Doherty CM, Forbes RB (2014). "Diagnostic Lumbar Puncture". Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.
- ↑ 2.0 2.1 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
- ↑ 3.0 3.1 3.2 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.
- ↑ 4.0 4.1 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.
- ↑ 5.0 5.1 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.
- ↑ Sempere AP, Berenguer-Ruiz L, Lezcano-Rodas M, Mira-Berenguer F, Waez M (2007). "[Lumbar puncture: its indications, contraindications, complications and technique]". Rev Neurol. 45 (7): 433–6. PMID 17918111.