viral meningitis csf protein

9,10 Aseptic meningitis is a condition that needs to be distinguished from other forms of meningitis that need a CSF analysis. Viral meningitis is spread through contaminated saliva, respiratory tract secretions and … Useful investigations in suspected viral meningitis. Protein. The CSF protein content is almost always elevated in bacterial meningitis (Tables 20-1 and 20-2). CSF protein and glucose. 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). In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy. 0.5-2 g/L. ‡ In tuberculous meningitis, CSF acid-fast staining can be insensitive, sensitivity of PCR is only about 50%, and culture requires up to 8 weeks. CSF white cell counts in viral meningitis are typically in the 20–500 cells ml −1 range; however, they may occasionally reach the 1000 cells ml −1 level. In addition, obtaining both serum and CSF viral loads can bolster diagnostic certainty and guide drug therapy adjustments . Since it is very sensitive even with early bacterial meningitis, it is often used to distinguish between bacterial and viral meningitis. The CSF findings are more suggestive of viral meningitis given the clear appearance of the CSF, the mildly raised WCC (consisting mainly of lymphocytes), raised protein level and normal glucose. It is markedly increased with bacterial meningitis. The additional CSF studies should include cell count, glucose, protein, gram stain, fungal smear, and PCR testing, which can guide appropriate antiviral therapy. 5. Viral meningitis is typically characterized by an elevated CSF white blood cell count, with a predominance of lymphocytes, and increased protein level. The CSF protein was 0.85 g/L and CSF glucose 3.5 mmol/L. You can almost certainly find that WBC count in viral meningitis is almost always less than 2000 cells/microL. The CSF is usually clear in viral meningitis. Normal is around 0.15-0.45g/L. CSF in Bacterial Meningitis. The cell count is usually high. Prospective investigation of a large outbreak of meningitis due to Echovirus 30 during summer 2000 in Marseilles, France. Objective: To clarify to what extent Gram stain-negative bacterial meningitis can be distinguished from viral meningitis by assessment of cerebrospinal fluid (CSF) and blood indices and serum C-reactive protein (CRP) in children over 3 months of age. CSF C-reactive protein and procalcitonin have not been shown to differentiate viral vs. bacterial meningitis compared to serum levels. Of these WBCs, you will likely find a majority of them being lymphocytes. A, C, D ~ In viral meningitis, CSF fluid is clear, protein levels are slightly increased, and glucose levels are normal. Meningitis can be community acquired or hospital acquired and caused by various micro organisms ranging from bacteria, virus, fungus, protozoa, etc. The CSF protein level usually is only slightly elevated, but it can range from normal to as high as 200 mg/dL. In most cases of viral meningitis, there is a mononuclear-predominant pleocytosis, although a neutrophil predominance has been described early in the course of enteroviral meningitis (ie, within the first 24 to 48 hours). The CSF protein content is almost always elevated in bacterial meningitis (Tables 20-1 and 20-2). Mild protein elevation may be caused by viral meningitis, neurosyphilis, subdural haematoma, cerebral thrombosis, brain tumour, multiple sclerosis (rarely >1.00 g/L) Moderate or pronounced elevation may be caused by acute bacterial meningitis, tuberculous meningitis, spinal cord tumour, cerebral haemorrhage, Guillain-Barre syndrome. 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. The CSF protein level (reference range, 20-50 mg/dL) is usually elevated in bacterial meningitis. Bernit BE, de Lamballerie X, Zandotti C, et al. Positive CSF interferon-gamma tests indicate tuberculous meningitis, but serum interferon-gamma tests may only indicate prior infection. Viral meningitis. Goals: It is unclear whether C reactive protein (CRP) and procalcitonin (PCT) levels in cerebrospinal fluid (CSF) improve the accuracy compared to their serum levels for the differential diagnosis of infectious meningitis. Viral meningitis does not cause cloudiness or increased turbidity of CSF. We report a case of a patient with the clinical picture for aseptic meningitis except for a CSF protein above 5 g/l. In viral meningitis, these levels are also usually elevated, though they can be within the reference range. Viral meningitis is a rare form of meningitis and is caused by inhalation of fungal spores. CSF C-reactive protein (CRP) is an acute phase reactant and is elevated with inflammation; it is markedly increased with bacterial meningitis. Only a small amount is normally present in CSF because proteins are large molecules and do not cross the blood/brain barrier easily. Protein leaks into the subarachnoid space from the blood, resulting in markedly increased CSF protein levels. In patients with cryptococcal meningitis, findings in the CSF are highly variable, and up to 40% of such patients have a normal CSF profile. Increases in protein are commonly seen with meningitis, brain abscess, and neurosyphilis. Three days later, an enterovirus was isolated from both CSF and stool culture, later confirmed to … For a definitive diagnosis of meningitis, you'll need a spinal tap to collect cerebrospinal fluid (CSF). Protein level: Elevated (>50 mg/dL) Additional tests: CSF Gram stain and cultures, blood cultures, CSF bacterial antigens, CSF polymerase chain reaction (PCR) for common viruses . Click to see full answer. The CSF protein level (reference range, 20-50 mg/dL) is usually elevated in bacterial meningitis. The CSF profile is abnormal in viral meningitis. In people with meningitis, the CSF often shows a low sugar (glucose) level along with an increased white blood cell count and increased protein. CSF white cell count and protein level are higher at birth and fall fairly rapidly in the first 2 weeks of life. Two large metaanalyses have concluded that elevated CSF lactate concentration is better than the CSF WBC count, glucose, or protein in differentiating bacterial meningitis from aseptic meningitis (sensitivity of 93% and 97% and specificity of 96% and 94%, respectively) [76, 77]. Protein levels. One of many studies showed higher CSF protein level in bacterial meningitis than viral meningitis, with mean 641.01±428.52 vs. 91.74±44.68 mg/dl [9, 11]. Viral meningitis is spread through contaminated saliva, respiratory tract secretions and … Bacterial meningitis leads to a more permeable blood brain barrier (due to increased inflammation). Viral meningitis is limited to the meninges and the CSF will not have an identifiable pathogen. Protein will be raised in meningitis (viral, bacterial or TB) as the result of blood-brain barrier disruption. The CSF is usually turbid or purulent in appearance. Cerebrospinal fluid (CSF) analysis - Meningitis. Clinicians should be aware that in rare situations very high CSF protein can be seen in self-limiting aseptic meningitis… Viral meningitis is limited to the meninges and the CSF will not have an identifiable pathogen. Further investigations including CSF PCR would be … CSF C-reactive protein (CRP) is an acute phase reactant and is elevated with inflammation. Several studies have shown that protein levels are increased at least to some degree in more than 95% of patients, and its absolute value is over 80 mg/dl in more than 80% of patients. Table 2. Viral meningitis is a rare form of meningitis and is caused by inhalation of fungal spores. Normal glucose level should be the 2/3 of serum glucose value (both samples should be taken at the same time). Mildly increased. CSF glucose. The aim of this study was to compare the accuracy of CRP and PCT levels in CSF and serum in order to differentiate between bacterial and viral meningitis. Characteristics include usually normal opening pressure, slightly increased protein and normal glucose (glucose is below normal for bacterial meningitis). CSF white blood cell (WBC) count in the CSF is usually less than 250 cells / microL. Several studies have shown that protein levels are increased at least to some degree in more than 95% of patients, and its absolute value is over 80 mg/dl in more than 80% of patients. Bacterial meningitis is life threatening, and must be distinguished from the more common aseptic (viral) meningitis. increased in infection: Tb > bacterial > viral; increased in GBS, vasculitis and sarcoidosis; oligoclonal bands in multiple sclerosis; increased in CNS inflammation (including CSF drains and blood in CSF) GLUCOSE. In syphilitic meningitis, abnormal CSF protein levels (elevated) and CSF glucose levels (decreased) may be observed in 10-70% of cases. The CSF protein … The clues that the doctor uses are the levels of white cells, protein and glucose in the CSF. Glucose. If there is a high clinical suspicion of meningitis, children who have a normal CSF should still be treated with IV antibiotics, pending cultures. 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. For additional details, refer to UpToDate content on CSF interpretation in children with viral meningitis. Total protein is elevated more than 95% of the time in bacterial meningitis and is >200 mg/dL more than half the time. From: Pediatric Secrets (Fifth Edition), 2011. In viral meningitis CSF protein is typically normal or mildly elevated: >0.45g/L in 50% and >1g/L in 16%. The levels are usually a lot higher in bacterial meningitis. ... CSF protein level ≥ 50 mg per dL (0.50 g per L) PROTEIN. CSF protein, glucose, gram stain, cultures, wbc, leukocytes. CSF lactate dehydrogenase (LDH) – is sometimes used to differentiate between bacterial and viral meningitis also. CSF protein (N: 0.15-0.45 g/L) Very high >1.5 g/L. WBC corrections Reduce wbc by one cell for every 700 RBC¿OR; WBC (corr) = WBC (CSF) ¿ WBC (blood) x RBC(CSF)/RBC (blood) Normal csf glucose is ~ 2/3 of serum glucose; Corrected protein: subtract 1mg/ml for every 1000 RBC Aseptic meningitis is defined as clinical and laboratory evidence of inflammation of the meninges (e.g., CSF pleocytosis and increased protein) without evidence of bacterial infection on Gram stain or culture. Gram stain is negative. CSF protein levels of at least 150 mg per dL (1.5 g per L)—as seen in many infectious and inflammatory conditions, or as a result of a traumatic tap … 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). Normal is about 2/3 the concentration of blood glucose. The cell count may be around 10 to 2000 and may show excess of lymphocytes. Test. As another example, PMNs sometimes predominate in viral, fungal, TB, or carcinomatous meningitis. 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. Aseptic Meningitis. Which CSF protein levels suggest viral meningitis? CSF protein. CSF in Viral Meningitis. CSF protein is usually less than 150 mg/dL. CSF glucose is less than 50 mg/dL about 70% of the time. Glucose and protein levels are normal. Spinal tap (lumbar puncture). Meningitis can occur in children with normal CSF microscopy. 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. This shift from predominantly neutrophilic to lymphocytic pleocytosis was most consistent with viral meningitis, and the child was discharged home. The CSF in these cases is with absence of bacterial or fungal colonies. Chemistry: protein ↑; glucose ↓ Microbiologic Analysis: a. Cryptococcal antigen testing (of CSF and serum) Sensitive ( >90% cases are positive) India Ink preparation Was the traditional method Positive in 50% cases; less sensitive CSF mixed with India Ink; clear gelatinous capsule of … Conclusion Appearance: Clear; Opening pressure: Normal or elevated; WBC count: 10-1000 cells/µL Classically lymphocytes but may be PMN early

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