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I. Typical Cerebrospinal Fluid Qualitative & Quantitative Analysis Profile of Different Etiologies of Meningitis
Opening
20-25 cm H2O 18-25 cm H2O 9-20 cm H2O 18-30 cm H2Oa 8-20 cm H2O
Pressure
Presence of
(-) (-) (+) (-) (-)
RBCs
Lymphocytic
predominance
Differential PMN Lymphocytic Lymphocytic Mononuclear
(initial PMN
Count predominance predominance predominance predominance
predominance
may occur)
Decreased but
Normal or only Decreased or
Glucose < 40 mg/dLd not as much as 60% of serum
slightly increased normal
bacterial
References:
Deisenhammer, F. et al. Guidelines on routine cerebrospinal fluid analysis. Report from an ENFS task force.
2006. Eur J Neurol, 13(9): 913-922.
Hastin, M.M. 2010. CSF Analysis. Michigan Medical Confluence. Accessed on 4 Oct 2018 <https://wiki.med.
umich.edu/display/NEURO/CSF+Analysis>
Hasun, R. et al. 2017. Meningitis Workup. Medscape. Accessed on 4 Oct 2018 <https://emedicine.
medscape.com/article/232915-workup#c12>
Seehusen, D.A. et al. 2003. Cerebrospinal Fluid Analysis. Am Fam Physician, 68(6): 1103-1109
II. Most Common Pathogens Affecting Patients by Profile
Patients of extremes of age, who are alcoholics, ICC status, with sickle cell
Streptococcus pneumoniae
anemia, with basilar skull fracture, or status-post splenectomy (most common)
Neisseria meningitides In children and adolescents; very rare in patients over 50 years old, ICC patients
Staphylococcus aureus,
In post-operative neurosurgery patients
Groups A & D Streptococcus
Klebsiella, Proteus,
In patients status-post lumbar puncture, spinal anesthesia, or shunting surgeries
Pseudomonas
Haemophilus influenzae
Cefepime; Chloramphenicol;
β-Lactamase (+) Cefotaxime or Ceftriaxone
Aztreonam; Fluoroquinolone
Neisseria meningitides
Cefotaxime or Ceftriaxone;
Penicillin MIC < 0.1 μg/mL Penicillin G or Ampicillin
Chloramphenicol
Chloramphenicol; Fluoroquinolone;
Penicillin MIC 0.1-1.0 μg/mL Cefotaxime or Ceftriaxone
Meropenem
Streptococcus pneumoniae
Cefotaxime or Ceftriaxone;
Penicillin MIC < 0.1 μg/mL Penicillin G or Ampicillin
Chloramphenicol
Staphylococcus aureus
Trimethoprim-Sulfamethoxazole;
Methicillin resistant Vancomycin
Linezolid; Daptomycin
References:
Brouwer, M.C. et al. 2010. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial
Meningitis. Clin. Microbiol. Rev., 23(3): 467-492
Tunkel, A.R. et al. 2004. Practice Guidelines for the Management of Bacterial Meningitis. Clin Infect Diseases, 39(9):
1267-1284.
Tunkel, A.R. 2017. Initial therapy and prognosis of bacterial meningitis in adults. UpToDate. Accessed on 4
Oct 2018 <https://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis>