Bacterial meningitis lumbar puncture

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 >2.1mmol/l.^[1]^[2]

Lumbar puncture

Indications of lumbar puncture

Lumbar puncture is indicated in all pateints with strong suspicion of meningitis for the following reasons:^[3]

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:^[1]^[2]

A pressure of over 180 mmH2O ^[1]^[2]^[4]^[5]
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^[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]^[3]

Increased intracranial pressure
Mass lesion such as tumour
Thrombocytopenia
Bleeding diathesis

References

↑ ^1.0 ^1.1 ^1.2 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
↑ ^2.0 ^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.
↑ ^3.0 ^3.1 Doherty CM, Forbes RB (2014). “Diagnostic Lumbar Puncture”. Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.
↑ ^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.

Template:WikiDoc Sources

[pmid12432041-1] 1.0 ^1.1 ^1.2 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

[pmid8416268-2] 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.

[pmid25075138-3] 3.0 ^3.1 Doherty CM, Forbes RB (2014). “Diagnostic Lumbar Puncture”. Ulster Med J. 83 (2): 93–102. PMC 4113153. PMID 25075138.

[pmid21194480-4] 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.

[pmid21382412-5] 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.

[pmid17918111-6] 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.

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