Csf findings in bacterial and viral meningitis pro#
Therefore, there is need for adjunctive markers that would aid in the prompt diagnosis of bacterial meningitis (including infants with neurosurgical devices), with the potential to reduce unnecessary antibiotic exposure and complications related to treatment.īacterial meningitis is associated with activation of the inflammatory cascade and the production of both pro and anti-inflammatory cytokines ( 13, 14, 15, 16). Similarly, parameters such as CSF WBC have been shown to possess suboptimal sensitivity and specificity in diagnosis of bacterial meningitis in infants with neurosurgical devices ( 12).
However, no combination of CSF parameters has been shown to have ideal sensitivity and specificity ( 10, 11). In the face of antibiotic pretreatment and negative CSF cultures, clinicians often rely on interpretation of CSF white blood cell count (WBC), protein, glucose, and CSF Gram stain to make the presumptive diagnosis of bacterial meningitis ( 9).
Antibiotic exposure reduces the diagnostic yield of the CSF culture ( 8). Infants evaluated for early onset sepsis are also frequently exposed to maternal intrapartum antibiotics. Studies suggest that two-thirds of infants diagnosed with bacterial meningitis receive antibiotics prior to the LP ( 4, 7). However, the LP is often deferred in infants with cardiorespiratory instability, and antibiotics are initiated presumptively ( 4, 7). The gold standard for diagnosis is the cerebrospinal fluid (CSF) culture, obtained via a lumbar puncture (LP). Clinical signs are often nonspecific in infants. The diagnosis of meningitis in the neonatal intensive care unit (NICU) remains fraught with challenges. Mortality approaches 10%, and among survivors, meningitis significantly increases the odds of neurodevelopmental impairment ( 2, 6). Preterm and very low birth weight infants are at greater risk, due to the immaturity of the immune response, and the invasive procedures and devices necessary for survival ( 4, 5). Conclusion:ĬSF cytokine levels may aid diagnosis of bacterial meningitis, and facilitate decision-making regarding treatment for culture negative meningitis.īacterial meningitis remains an important cause of morbidity and mortality in infants ( 1, 2, 3), despite advances in medical care, the availability of broad-spectrum antibiotics, and strategies for prevention of perinatal and hospital-acquired infections ( 4, 5). A subset of antibiotic pretreated culture-negative subjects demonstrated cytokine patterns similar to culture positive subjects. CSF cytokines were highly correlated with each other and with CSF white blood cell count (WBC) counts in infants with meningitis. IL-6 and IL-10 were the individual cytokines possessing greatest accuracy in diagnosis of culture proven bacterial meningitis (ROC analyses area under the concentration-time curve (AUC) 0.91 0.9103 respectively), and performed as well as, or better than combinations identified using ROC and PCA. Six hundred and eighty four infants < 6 mo were included 11 had culture-proven bacterial meningitis. Receiver operating characteristic (ROC) analyses and Principal component analysis (PCA) were used to determine cytokine combinations that identified bacterial meningitis. In a prospective cohort study of infants, we used cytometric bead arrays to measure tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), IL-6, IL-8, IL-10, and IL-12 in CSF. Pro and anti-inflammatory cytokines are elevated in bacterial meningitis and may be useful diagnostic adjuncts when CSF cultures are negative. Antibiotic pretreatment and low bacterial density diminish cerebrospinal fluid (CSF) culture yield, while laboratory parameters do not reliably identify bacterial meningitis. Bacterial meningitis poses diagnostic challenges in infants.
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