CSF is produced at a rate of 0.2–0.7 mL per minute or 500–700 mL per day.1The main function of the CSF is to reduce buoyancy of the brain. The maximum cell count in CSF was 22 cells/mm 3, and overall normal glucose values but elevated protein levels were found in the CSF. In patients with tuberculous meningitis, the CSF is characterized by a predominantly lymphocytic pleocytosis; an elevated protein level, especially if a CSF block is present; and a low glucose level (< 40 mg/dL). In a patient with a predominance of polymorphonuclear leukocytes in the initial CSF specimen and in whom a viral infection is suspected, antibiotics may be withheld if a spinal tap is repeated within 12 hours. 2. Reference range is 40 to 80 mg/dL. The level will usually be increased with bacterial and fungal meningitis while it will remain normal or only slightly elevated with viral meningitis. Gram staining of the sample may demonstrate bacteria in bacterial meningitis, but absence of bacteria does not exclude bacterial meningitis; microbiological culture of the sample may still yield a causative organism. Normal Laboratory Values: CSF*. ... rapid, fast and inexpensive differentiation of bacterial vs. viral meningitis. Meningitis: Bacterial vs. A CSF glucose level lower than 50 per cent of a simultaneously drawn blood glucose determination is not uncommon in patients with viral meningitis due to mumps, LCM, and herpes simplex. When the plasma glucose level is 100 mg/dL, the CSF glucose level is usually about 65 mg/dL. The CSF glucose level may be low or normal, and the CSF protein level is sometimes elevated. He is admitted to a private room in a community hospital for adjustment of anti-seizure medication and to receive chemotherapy. Hypoglycorrhachia (low CSF glucose levels) can be caused by CNS infections, inflammatory conditions, subarachnoid hemorrhage, hypoglycemia (low blood sugar), impaired glucose transport, increased CNS glycolytic activity and metastatic carcinoma. CSF level of lactic acid is normal in viral meningitis. Spinal fluid glucose is decreased in 60 to 80% of bacterial meningitis cases. Because the PMN predominance quickly changes to a mononuclear cell predominance, a repeat lumbar puncture 6 … Headaches associated with Viral Meningitis are usually generalized and hard to pinpoint a … Cases of early viral meningitis can present with an increased number of cells and neutrophils but usually the CSF glucose is normal or not lower than 40% of the blood CSF value. viral meningitis had CSF lactate levels less than 3-8 mmol/l (34-5 mg/100 ml)-2 3 ±0 6 and 2-1 I 0-7 mmol/l (20-9 ±5*4 and 19 1 i6-4 mg/100 ml) respectively. The spinal fluid normally contains very little protein since serum proteins are large molecules that do not cross the blood-brain barrier. drug-induced aseptic meningitis from viral meningitis, in which re-covery usually requires 10 to 14 days.7 CSF glucose levels are usual-ly normal in drug-induced aseptic meningitis, which may help in dif-ferentiating it from bacterial menin-gitis in which glucose levels usually are low.4,6,7,10 Analysis of C-reactive protein Diagnosis of viral meningitis is based on analysis of CSF obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or a mass is suspected). Opening pressure (N: 8-20 cm H 2 O) Elevated (20-30 cm H 2 O) Normal or mildly increased. 1. (predominantly polymorphs) were high in bacterial meningitis, whereas, CSF glucose was high in viral meningitis. Hypoglycorrhachia, a low glucose level in the cerebrospinal fluid (CSF), is commonly associated with infections such as bacterial, fungal, and tuberculous meningitis 1. The clues that the doctor uses are the levels of white cells, protein and glucose in the CSF. Early in viral meningitis, the spinal fluid may have a predominance of polymorphonuclear (PMN) leukocytes. develops a rash and fever. D.F. CSF glucose levels can be useful in distinguishing among causes of meningitis as more than 50% of patients with bacterial meningitis have decreased CSF glucose levels while patients with viral meningitis usually have normal CSF glucose levels. Protein: High or very high. The propensity score was matched 1:1 between the two comparison groups controlling for age, sex, cerebrospinal fluid (CSF) white blood cell count, CSF glucose, and CSF … III. While neutrophil-predominant pleocytosis and a decreased glucose level in CSF can predict the presence of bacterial meningitis, the CSF/blood glucose ratio is more precise (optimal cut-off=0.36, sensitivity=92.9%, specificity=92.9%, area under the curve=.97) even after administration of antimicrobials prior to examination in the emergency department. An elevated CSF glucose level results from an elevated plasma glucose level. The amount of glucose present in CSF assists in the assessment of impaired glucose transfer from plasma to cerebrospinal fluid. Diagnostic tests for cryptococcal meningitis include cryptococcal antigen testing, India ink staining, and culture. The CSF sample is examined for white blood cells (and which subtypes), red blood cells, protein content and glucose level. < 50% of blood glucose (may be extremely low) Acid-fast staining. It is markedly increased with bacterial meningitis. better marker compared to other conventional markers including CSF glucose and CSF total number of leukocytes. Increased inflammation in bacterial meningitis results a higher ICP and thus a high opening pressure. Typically in bacterial meningitis the white cell count is much higher than in viral meningitis (and is a different type of white cell), the protein is much higher and the glucose is much lower than in viral meningitis. CSF … A decreased CSF glucose concentration may be due to hypoglycemia, bacterial meningitis, fungal meningitis, certain viral meningitides, subarachnoid hemorrhage, carcinomatosis meningitis, chemical meningitis, and parasitic meningitis. CSF protein concentration may rise due to 2 factors: either an increased permeability of the blood brain barrier allow… Mortality rate was also noticed higher in bacterial group as compared to viral one, 4 (7.54%) vs 1 (2.38%). Echoviruses, coxsackieviruses, and EV-71, the predominant causes of viral meningitis (see Table 1 ), may be cultured from the CSF, usually from the stool, and occasionally from the throat. Med. Typically, protein is slightly increased but less than that in acute bacterial meningitis (eg, < 150 mg/dL); however, the protein level can be very high in West Nile virus meningitis. Bacterial meningitis. CSF lactate dehydrogenase (LDH) – is sometimes used to differentiate between bacterial and viral meningitis also. ↓ CSF/serum glucose ratio < 0.5 ↑↑ Viral meningitis < 1,000 cells/µL, dominantly lymphocytic ↑ (e.g., 50—150 mg/dL) ↔: Normal: CSF/serum glucose ratio. Reference Range of CSF glucose levels: ∙ 60% - 70% of plasma concentration∙ Should always be accompanied by a blood glucose test. CSF C-reactive protein and procalcitonin have not been shown to differentiate viral vs. bacterial meningitis compared to serum levels. Typically, protein is slightly increased but less than that in acute bacterial meningitis (eg, < 150 mg/dL); however, the protein level can be very high in West Nile virus meningitis. Crit. Viral meningitis and neurosyphilis usually do not affect spinal fluid glucose concentration. This helps to distinguish viral from bacterial meningitis, which has a much higher cell count and a predominance of PMNs in the cell differential; this is by no means an absolute rule, however. Bacterial meningitis was more common in young infants and older adults; and viral meningitis had a peak incidence in August. Decreased level of glucose is due to: In the diabetic patient with hypoglycemia. CSF glucose levels can be useful in distinguishing among causes of meningitis as more than 50% of patients with bacterial meningitis have decreased CSF glucose levels while patients with viral meningitis usually have normal CSF glucose levels. Bacterial meningitis. The CSF/serum glucose ratio is a measurement of the glucose in the CSF compared with the blood glucose level. The mean CSF lactate level in bacterial meningitis cases amounted to 16.51 ± 6.14 mmol/l , whereas it was significantly lower in viral group 2.36 ± 0.6 mmol/l, p <.0001. In bacterial meningitis, the CSF glucose level (reference range, 40-70 mg/dL) is less than 40 mg/dL in 60% of patients. Glucose• Decreased level• Acute pyogenic meningitis• Hypoglycemia• Metastatic meningeal carcinoma• Increased level• Hyperglycemia• Normal level• Viral encephalitis• Brain tumor• Sodium• Increased – salt poisoning – swine• Chlorides• Reduced – pyogenic meningitis 15. While not diagnostic, trends in protein and glucose levels can hint towards whether the infectious cause is viral, bacterial, or fungal (Table 1). Indication: Increased glucose level is due to: In diabetic patients with hyperglycemia. CSF lactate dehydrogenase (LD) — used to differentiate between bacterial and viral meningitis; may also be elevated with leukemia or stroke. Meningitis… Hypoglycorrhachia—low CSF glucose—has been recognized since the 1930s 1,2 as a critical clinical laboratory finding with the potential to influence treatment of meningitis and is therefore reported within 1 hour by most laboratories. To investigate or exclude meningitis: bacterial, viral, tuberculous, cryptococcal, chemical, carcinomatous. a. Bacterial meningitis is a … Glucose: Low glucose levels, as compared with plasma levels, are seen in bacterial meningitis, cryptococcal meningitis, malignant involvement of the meninges and sarcoidosis. Low glucose concentrations may also occur when there are increased white cells or in malignant infiltration of the CSF because of an increase in metabolism. CSF Glucose. PROTEIN Total protein levels in CSF are normally very … Appearance: Cloudy and turbid. is a 65-year-old male who has brain cancer. Cerebrospinal fluid (CSF) is a clear fluid produced from the blood that circulates around the brain and spinal cord, the organs that make up the central nervous system. A number of conditions give deranged CSF readings and therefore knowledge of which conditions affect the different values is vital. Glucose (mg/dL): Normal to marked decrease. Postgrad. One may also ask, what happens to CSF in meningitis? However, normal results don’t rule out the possibility of infection. The CSF glucose concentration is low when the CSF/serum glucose ratio is < 0.6. The normal = 50 to 80 mg/dL. Meningitis is always cerebrospinal infection. 2. The levels are usually a lot higher in bacterial meningitis. Normal results mean that your CSF glucose levels are within normal range. Acerebrospinalfluid (CSF) glucose level lessthan 1.9 mmol/L, a CSF-blood glucose ratiolessthan 0.23, a CSF protein level greater than2.2 g/L, more than2000 \m=x\ 106/L CSF leukocytes, ormore than 1180 \m=x\ 106/LCSF poly- The mean CSF lactate level in bacterial meningitis cases amounted to 16.51 ± 6.14 mmol/l , whereas it was significantly lower in viral group 2.36 ± 0.6 mmol/l, p <.0001. CSF glucose level is usually depressed, ranging from 10 to 39 mg/dL, and the CSF protein level is elevated, ranging from 50 to 700 mg/dL. Test. The main protein in CSF is albumin, a large protein playing an important part in the body’s fluid balance. The CSF protein level usually is only slightly elevated, but it can range from normal to as high as 200 mg/dL. Bacterial Meningitis. Your doctor will provide treatment based on the cause of your symptoms. Is CSF high in glucose? Spinal tap (lumbar puncture). CSF glucose: normal is about 2/3 the concentration of blood glucose. Glucose is the common sugar used in the body. In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. If CSF eosinophils are present, the possibility of coccidioidal meningitis increases. The CSF glucose level is divided by the blood glucose (the ratio of CSF glucose to serum glucose) and a ratio ≤ 0.4 is indicative of bacterial meningitis (2). 2. CSF protein electrophoresis. There were no deaths at 28 days. Levels of glucose in the cerebrospinal fluid (CSF) are used to discriminate bacterial meningitis from viral meningitis. 0–5 x 10 6 lymphocytes/L. The hospital stay was longer in bacterial than viral meningitis cases (9.52 ± 3.4 vs 6.82 ± 2.7 days), p .0001. 40–80 mg/dL (< 40% of simultaneously measured plasma level if that plasma level is abnormal) Care Med. Conventional Units. Unlike viral etiologies of meningitis, in bacterial causes, you will see a neutrophilic predominance on CSF analysis. Defective Glucose Transport. Viral meningitis does not cause cloudiness or increased turbidity of CSF. 0–5 lymphocytes/mcL. Most of the protein that is normally present is albumin. In viral meningitis the infection is limited to the meninges, and the CSF will not have an identifiable pathogen. Table 1: Typical cerebrospinal fluid profiles for bacterial, viral, and fungal meningitis. CSF C-reactive protein (CRP) is an acute phase reactant and is elevated with inflammation. Protein (mg/dL) … Xanthochromia or CSF bilirubin: Bacterial Meningitis. CSF protein concentration will be above 250 mg/dL, and CSF glucose concentrations are usually lower than 45 mg/dL. Viral Meningitis. It also supplies nutrients as well as helps in removal of various substances like amino acids, neurotransmitters, metabolic byproducts and cells. Clin. There are several types of this disease, including bacterial, viral, and fungal. PCR is also recommended for virus detection. none of the patients with viral meningitis had lactate level >3.8 mmol/l. A decreased CSF glucose level is not a feature of arboviral encephalitis, including West Nile encephalitis . 1. Typically in bacterial meningitis the white cell count is much higher than in viral meningitis (and is a different type of white cell), the protein is much higher and the glucose is much lower than in viral meningitis. Viral Meningitis (Aseptic Meningitis) Viral Meningitis is the most common form of meningitis in the United States. White cells: Raised neutrophils. It level would be low in bacterial or TB meningitis as the bacteria take up glucose for energy. The average CSF protein in bacterial meningitis group was 102.4mg/dl, in viral meningitis group 33.6, tuberculous meningitis group 89.4 and in the partially treated group was 75.47mg/dl. For an objective assessment of CSF glucose, a blood glucose check will be conducted as a baseline. Interpretation: Decreased CSF Glucose (Hypoglycorrhachia) Hypoglycemia. CSF: cerebrospinal fluid; WBC: white blood cell. Acerebrospinalfluid (CSF) glucose level lessthan 1.9 mmol/L, a CSF-blood glucose ratiolessthan 0.23, a CSF protein level greater than2.2 g/L, more than2000 \m=x\ 106/L CSF leukocytes, ormore than 1180 \m=x\ 106/LCSF poly- Therefore, normal CSF glucose levels lie between 2.2 and 4.4 mmol/L. 88:217–223. The usefulness of CSF lactic acid levels in central nervous system infections with decreased cerebrospinal fluid glucose. Rarely the CSF glucose level may be low, as in fungal and tuberculous meningitis. <40 mg/dL. For information on performing a lumbar puncture and sampling, see the separate Lumbar Puncturearticle. CSF glucose levels are normally about 60% of blood glucose levels. Glucose levels are usually normal in viral infections of the CNS. The CSF glucose may vary with the serum glucose. Meningitis can be caused by bacterial, fungal or viral pathogens. 49–51 In one study a cut-off of 54mg/dL had a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96.3%, with an accuracy of 97.2%. Chemical Meningitis. Decreased à may be due to hypoglycemia (low blood sugar), bacterial or fungal infection (such as meningitis), tuberculosis, or certain other types of meningitis. In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy. A CSF/serum glucose ratio < 0.4 is highly suggestive of bacterial meningitis but may also be seen in other conditions, including fungal, tuberculous, and carcinomatous meningitis. The CSF glucose level is usually within the reference range in viral meningitis, but it may be low in some cases of LCM, HSV, mumps virus, or poliovirus infection. Specimen requirement is 1 mL of spinal fluid. By: ADVANCE Staff June 11, 2015. Case Study. Red cells: Normal. Contamination with peripheral blood. Children with bacterial meningitis hadCSFlactate levels from 3-9 mmol/l (35-4 mg/100 ml) to greater than 10 0 mmol/l Table 1 CSFmeasurements (meansandSD)madein 205children Conclusion: In combination with а validated meningitis clinical prediction rule, the CSF lactate level can be used to distinguish between bacterial and viral meningitis in children. Cerebrospinal fluid (CSF) glucose levels may be decreased in any central nervous system infection, although levels are typically normal in viral meningitis, low in bacterial meningitis, and may be normal or low in fungal meningitis. Viral Meningitis causes mild fevers, not high fevers. true (normal or a little low) In bacterial meningitis protein levels will be (high/low/normal), in viral meningitis protein levels will be (high/low/normal) high; high. PCR. Appearance: Clear, cloudy, or purulent. Xpert MTB/RIF§. Normal glucose level should be the 2/3 of serum glucose value (both samples should be taken at the same time). PubMed. CSF lactate dehydrogenase (LD) - used to differentiate between bacterial and viral meningitis. Protein levels. Glucose (CSF : blood ratio) Bacterial meningitis : 100–10,000 (but may be normal) Usually < 100 >1.0 (but may be normal) <0.4 (but may be normal) Viral meningitis : Usually <100 Meningitis was diagnosed in 3 children (12%), and encephalitis with seizures was diagnosed in 1 child (4%). Within 48 hours of admission D.F. Bacterial meningitis can be life-threatening and spreads between people in close contact with each other. 4. Another hallmark of Viral Meningitis is a normal blood glucose level, not high or low. GLUCOSE CSF glucose is normally approximately two-thirds of the fasting plasma glucose. For the asceptic meningitis group, 37 patients were included with mean age of 38 and average APACHE II score of 3. Granulomatous process. The level will usually be increased with bacterial and fungal meningitis while it will remain normal or only slightly elevated with viral meningitis. SI Units. T/F, in viral meningitis, the glucose CSF level will still be normal. It is worth remembering that glucose in the CSF tends to be normal in viral meningitis. Glucose. Glucose preferentially passes through the bloodbrain barrier to enter the CSF, resulting in a normal value of 60 to 70% of plasma glucose. Protein levels above 1 gm/dL suggest a subarachnoid block. Increases in protein are commonly seen with meningitis, brain abscess, and neurosyphilis. The glucose level in CSF is proportional to the blood glucose level and corresponds to 60-70% of the concentration in blood. Therefore, normal CSF glucose levels lie between 2.5 and 4.4 mmol/L (45-80 mg/dL). Glucose. 1. For a definitive diagnosis of meningitis, you'll need a spinal tap to collect cerebrospinal fluid (CSF). Normal levels of glucose in the CSF are greater than 50 mg/dL, or 2.8 mmol/L. PMNs and lymphocytes (usually mixed pleocytosis) Elevated. The glucose level in CSF is proportional to the blood glucose level and corresponds to 60-70% of the concentration in blood. Tuberculous meningitis‡. If your doctor finds abnormalities in CSF glucose measurement, you may need further tests. The glucose level is normal in most cases, but severe hypoglycorrhachia has been reported, especially with LCMV or the mumps virus. CSF Glucose does not usually rise above 300 mg/dl. The changes in various conditions are given below. Among the viral infections that present as aseptic meningitis, meningoencephalitis, or encephalitis, a decreased CSF glucose level may occur in CNS infections due to mumps virus, enteroviruses, and lymphocytic choriomeningitis virus, in addition to HSV-1 and viral infections presenting as aseptic meningitis, meningoencephalitis, or encephalitis. Why is there a decrease in CSF glucose levels in patients with bacterial meningitis? The Gram stain is negative, and CSF glucose is normal. All scores are shown as percent, n value, or mean (SD). CSF glucose concentration. Mechanism. To A, C, D ~ In viral meningitis, CSF fluid is clear, protein levels are slightly increased, and glucose levels are normal. A blood sample for determining glucose levels should be drawn before the spinal tap is performed. Normal Range. Viral meningitis lab tests include non specific blood tests like the cbc, blood culture, PT and PTT tests. Viral meningitis. Cerebrospinal fluid glucose levels are also affected by blood glucose levels. Diagnosis of viral meningitis is based on analysis of CSF obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or a mass is suspected). CSF white-cell counts can often be higher in patients receiving antiretroviral therapy. CSF Glucose is two thirds of Serum Glucose. Traumatic puncture. Laboratory tests on samples other than CSF—may be requested with or following CSF testing and may include: Blood glucose… Viral cultures from CSF are positive in young children with enteroviral meningoencephalitis but only seldom, in < 5%, in other cases [53, 54], (Class III). CSF glucose (N: 2.8-4.4 mmol/L; blood:CSF glucose ratio is normally 0.3-0.9) Decreased (<2.2 mmol/L) Normal Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord. The clues that the doctor uses are the levels of white cells, protein and glucose in the CSF. In addition, he also has a very low glucose CSF level (CSF, blood glucose ratio of 25%) and an increased protein value sometimes. Therefore, normal CSF glucose levels … Meningitis 1. CSF level of lactic acid increases in bacterial and fungal meningitis. Protein. The answer is D: mononuclear pleocytosis in the CSF. The CSF protein level (reference range, 20-50 mg/dL) is usually elevated in bacterial meningitis. CSF glucose Glucose levels in CSF normally reflect the levels seen in the blood. Whilst not diagnostic, low glucose levels, as compared to plasma levels, are seen in bacterial meningitis, cryptococcal meningitis, malignant involvement of the meninges and sarcoidosis. Glucose levels are usually normal in viral infections of the CNS. Opening pressure: Usually elevated … terial from viral meningitis.9 Quick resolution of symptoms is an important sign that distinguishes drug-induced aseptic meningitis from viral meningitis, in which re-covery usually requires 10 to 14 days.7 CSF glucose levels are usual-ly normal in drug-induced aseptic meningitis, which may help in dif-ferentiating it from bacterial menin- Cell count. none of the patients with viral meningitis had lactate level >3.8 mmol/l. CSF lactate was found to be a useful tool to differentiate bacterial from viral meningitis when elevated. Viral. What cells produce CSF… Bacteria l Tuberculosis. Other tests include some tissues swabbing like the throat and nose swab to detect the viruses. A glucose level below 40 mg/dL is significant and occurs in bacterial and fungal meningitis and in malignancy. The symptoms are typically more mild that bacterial meningitis and often the infection will resolve without treatment. BM, bacterial meningitis; TBM, tuberculous meningitis; VM, viral meningitis. Nucleic acid detection For nucleic acid detection, polymerase chain reaction … Cheryl Bade CSF glucose levels can be used to distinguish between viral meningitis and bacterial meningitis. Mycobacterial culture (ideally using a CSF sample of ≥ 30 mL) Interferon-gamma tests of serum and (if available) CSF. The lactic acid level can also be increased in patients with some forms of mitochondrial diseases that affect the CNS. The average CSF sugar value in bacterial meningitis was 29.5mg/dl, in viral 68.4mg/dl,in Tuberculous meningitis 23.3and in partially treated group was 43.03mg/dl. This is not the case for viral meningitis, where the glucose level is normal. Cerebrospinal fluid (CSF) glucose levels may be decreased in any central nervous system infection, although levels are typically normal in viral meningitis, low in bacterial meningitis, and may be normal or low in fungal meningitis. CSF glucose levels are normally about 60% of blood glucose levels. Bacterial vs. viral meningitis—the importance of CSF lactic acid. CSF lactic acid levels are a useful way to determine the etiology of decreased CSF glucose levels by differentiating bacterial versus viral CNS infections .
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