Detection of herpes viruses in the cerebrospinal fluid of adults with suspected viral meningitis in Malawi

Meningitis is referred to as an inflammatory process of the leptomeninges and cerebrospinal fluid (CSF) within the sub-arachnoid space of the brain. We have investigated glucose status in CSF in different types of meningitis together with detailed medical history in children. In addition, we have also carried out the detailed cytological and microbiological examinations. A total of 40 subjects were investigated. We observed that the glucose level was significantly decreased (<20 mg/dl) in 65%, moderately decreased (20-40 mg/dl) in 20% and mildly decreased (40-50mg/dl) in 15% of the patients in our study. Patients with Pyogenic meningitis had tremendously reduced glucose level (9.0 mg/dl) in their CSF whereas in viral meningitis the CSF glucose level is highly variable (10 to 65 mg/dl). Furthermore, 5 (12.5%) patients showed high lymphocyte counts and 34 (85%) patients showed high neutrophil counts. Interestingly, in Pyogenic meningitis, the neutrophil count was very high compared to that in viral meningitis. The present study clearly demonstrates that biochemical parameters such as glucose level in CSF might be a potential tool for detecting meningitis and as well as differentiation of the different types of meningitis. DOI: http://dx.doi.org/10.3329/cujbs.v6i1-2.17080 The Chittagong Univ. J. B. Sci.,Vol. 6(1&2):41-49, 2011

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Acute Viral Meningitis

10.2310/neuro.6269 ◽

2015 ◽

Author(s):

Karen L. Roos ◽

Jared R. Brosch

Keyword(s):

Cerebrospinal Fluid ◽

Viral Meningitis ◽

Viral Pathogen ◽

Meningeal Irritation ◽

Nuchal Rigidity ◽

Common Causes ◽

Neurologic Sequelae ◽

Control And Prevention ◽

Csf Pleocytosis ◽

The Brain

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This chapter contains 4 highly rendered figures, 7 tables, 16 references, and 5 MCQs.

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Acute Viral Meningitis

10.2310/fm.1269 ◽

2018 ◽

Author(s):

Karen L. Roos ◽

Jared R. Brosch

Keyword(s):

Cerebrospinal Fluid ◽

Viral Meningitis ◽

Viral Pathogen ◽

Meningeal Irritation ◽

Nuchal Rigidity ◽

Common Causes ◽

Neurologic Sequelae ◽

Control And Prevention ◽

Csf Pleocytosis ◽

The Brain

Acute viral meningitis refers to inflammation of the meninges of the brain in response to a viral pathogen. Viruses cause meningitis, encephalitis, myelitis, or a combination of these, meningoencephalitis or encephalomyelitis. Viral meningitis is typically a self-limited disorder with no permanent neurologic sequelae. This chapter reviews the epidemiology, etiology, diagnosis, differential diagnosis, treatment, complications, and prognosis. Tables describe Wallgren’s criteria for aseptic meningitis, important arboviral infections found in North America, herpes family viruses and meningitis, classic cerebrospinal fluid (CSF) abnormalities with viral meningitis, Centers for Disease Control and Prevention criteria for confirming arboviral meningitis, basic CSF studies for viral meningitis, and etiology of CSF pleocytosis. Figures depict common causes of viral meningitis, nuchal rigidity, examination for Kernig sign, and Brudzinski sign for meningeal irritation. This review contains 4 highly rendered figures, 8 tables, and 17 references.

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Phosphatidylcholine PC ae C44:6 in cerebrospinal fluid is a sensitive biomarker for bacterial meningitis

Journal of Translational Medicine ◽

10.1186/s12967-019-02179-w ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Leonardo Silva de Araujo ◽

Kevin Pessler ◽

Kurt-Wolfram Sühs ◽

Natalia Novoselova ◽

Frank Klawonn ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Cell Count ◽

Negative Predictive Value ◽

Predictive Value ◽

Characteristic Curve ◽

Viral Meningitis ◽

Acute Bacterial Meningitis ◽

Membrane Phospholipids ◽

Cns Disorders

Abstract Background The timely diagnosis of bacterial meningitis is of utmost importance due to the need to institute antibiotic treatment as early as possible. Moreover, the differentiation from other causes of meningitis/encephalitis is critical because of differences in management such as the need for antiviral or immunosuppressive treatments. Considering our previously reported association between free membrane phospholipids in cerebrospinal fluid (CSF) and CNS involvement in neuroinfections we evaluated phosphatidylcholine PC ae C44:6, an integral constituent of cell membranes, as diagnostic biomarker for bacterial meningitis. Methods We used tandem mass spectrometry to measure concentrations of PC ae C44:6 in cell-free CSF samples (n = 221) from patients with acute bacterial meningitis, neuroborreliosis, viral meningitis/encephalitis (herpes simplex virus, varicella zoster virus, enteroviruses), autoimmune neuroinflammation (anti-NMDA-receptor autoimmune encephalitis, multiple sclerosis), facial nerve and segmental herpes zoster (shingles), and noninflammatory CNS disorders (Bell’s palsy, Tourette syndrome, normal pressure hydrocephalus). Results PC ae C44:6 concentrations were significantly higher in bacterial meningitis than in all other diagnostic groups, and were higher in patients with a classic bacterial meningitis pathogen (e.g. Streptococcus pneumoniae, Neisseria meningitidis, Staphylococcus aureus) than in those with less virulent or opportunistic pathogens as causative agents (P = 0.026). PC ae C44:6 concentrations were only moderately associated with CSF cell count (Spearman’s ρ = 0.45; P = 0.009), indicating that they do not merely reflect neuroinflammation. In receiver operating characteristic curve analysis, PC ae C44:6 equaled CSF cell count in the ability to distinguish bacterial meningitis from viral meningitis/encephalitis and autoimmune CNS disorders (AUC 0.93 both), but had higher sensitivity (91% vs. 41%) and negative predictive value (98% vs. 89%). A diagnostic algorithm comprising cell count, lactate and PC ae C44:6 had a sensitivity of 97% (specificity 87%) and negative predictive value of 99% (positive predictive value 61%) and correctly diagnosed three of four bacterial meningitis samples that were misclassified by cell count and lactate due to low values not suggestive of bacterial meningitis. Conclusions Increased CSF PC ae C44:6 concentrations in bacterial meningitis likely reflect ongoing CNS cell membrane stress or damage and have potential as additional, sensitive biomarker to diagnose bacterial meningitis in patients with less pronounced neuroinflammation.

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Survay of Cerebrospinal Fluid (CSF and C-Reactive Protein (CRP) for Differentiation of Bacterial and Viral Meningitis in Loghman Hakim, Aliasghar and Valiasr Hospitals of Zanjan

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2008.05.1298 ◽

2008 ◽

Vol 12 ◽

pp. e462

Author(s):

D.R. Asadi ◽

B. Amini

Keyword(s):

Cerebrospinal Fluid ◽

Viral Meningitis ◽

C Reactive Protein ◽

Reactive Protein

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Comparison of Cerebrospinal Fluid Biomarkers for Differential Diagnosis of Acute Bacterial and Viral Meningitis with Atypical Cerebrospinal Fluid Characteristics

Medical Principles and Practice ◽

10.1159/000501925 ◽

2019 ◽

Vol 29 (3) ◽

pp. 244-254 ◽

Cited By ~ 1

Author(s):

Sérgio Monteiro de Almeida ◽

Suélen Maria Parizotto Furlan ◽

Arianne Maris Munhoz Cretella ◽

Bruna Lapinski ◽

Keite Nogueira ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Differential Diagnosis ◽

Positive Likelihood Ratio ◽

Viral Meningitis ◽

Acute Bacterial Meningitis ◽

Blood Levels ◽

Csf Biomarkers ◽

Control Groups ◽

Easy Method ◽

Csf Lactate

Objective: Several cerebrospinal fluid (CSF) biomarkers are used to distinguish between acute bacterial meningitis (BM) and viral meningitis (VM). We compared the ability of lactate and glucose (GL) in CSF and the CSF/blood GL ratio to distinguish between acute BM and VM with typical and atypical CSF characteristics. Methods: Three hundred and twenty-four CSF reports were included, which were distributed as the acute BM, VM, and normal control groups (n = 63, 139, and 122, respectively). Results: Lactate level in the CSF of acute BM group was 4-fold higher than that in the acute VM and control groups (p < 0.0001). CSF lactate presented higher specificity (92%) and negative predictive value (94%) compared to CSF GL and CSF/blood GL ratio in distinguishing acute BM and VM. Definitive acute BM or VM with atypical CSF cell characteristics was observed in 23.2 and 21.6% of samples, respectively, and these groups showed reduced performance of characteristics of all CSF biomarkers. CSF lactate showed better operational characteristics than those of CSF GL and CSF/blood GL ratio, presenting the highest positive likelihood ratio, and thus aided in the differential diagnosis of VM with atypical CSF. Conclusion: The CSF lactate assay can be routinely used in laboratories as a rapid, automated, and easy method that is independent of lactate blood levels.

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Laboratory surveillance of viral meningitis by examination of cerebrospinal fluid in Cape Town, 1981–9

Epidemiology and Infection ◽

10.1017/s095026880005706x ◽

1993 ◽

Vol 111 (2) ◽

pp. 357-371 ◽

Cited By ~ 28

Author(s):

J. P. McIntyre ◽

G. A. Keen

Keyword(s):

Cerebrospinal Fluid ◽

Aseptic Meningitis ◽

Laboratory Data ◽

Cape Town ◽

Viral Meningitis ◽

Laboratory Surveillance ◽

Coxsackie B

SummaryNine years accumulated laboratory data derived from the culture of the cerebrospinal fluid of 11 360 aseptic meningitis cases were retrospectively reviewed to establish the epidemiology of viral meningitis in Cape Town. Virus was isolated from 3406 of the cases (91% enteroviruses and 9% mumps).Five major summer viral meningitis episodes were documented: two of echovirus 4 (706 and 445 cases), echovirus 9 (223), coxsackie A9 (104) and one of unidentified enterovirus (324 cases – probably echo 9). Although coxsackie B was endemic, clusters of one or other type were dominant at any one time. Mumps was endemic. Sixty-two percent of all viral cases were <5 years old. The median ages of 4 and 5 years in echoviruses 9 and 4 (the epidemic strains) contrasted with that of 1 year in coxsackie B (with many cases <3 months old). Mumps peaked at 3–4 years of age. Males dominated overall, particularly in mumps.

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Tumor necrosis factor alpha in cerebrospinal fluid during bacterial, but not viral, meningitis. Evaluation in murine model infections and in patients.

Journal of Experimental Medicine ◽

10.1084/jem.167.5.1743 ◽

1988 ◽

Vol 167 (5) ◽

pp. 1743-1748 ◽

Cited By ~ 164

Author(s):

T P Leist ◽

K Frei ◽

S Kam-Hansen ◽

R M Zinkernagel ◽

A Fontana

Keyword(s):

Cerebrospinal Fluid ◽

Bacterial Meningitis ◽

Systemic Infection ◽

Lymphocytic Choriomeningitis ◽

Viral Meningitis ◽

Tnf Alpha ◽

Mononuclear Leukocytes ◽

Necrosis Factor Alpha ◽

Factor Alpha ◽

Listeria Infection

To evaluate the potential role of cachectin/TNF-alpha in the pathogenesis of bacterial and viral meningitis, concentrations and kinetics of TNF-alpha were determined in cerebrospinal fluid (CSF). After intracerebral, but not systemic, infection with Listeria monocytogenes in mice, TNF-alpha was detected as early as 3 h after infection reaching maximum titers after 24 h. However, TNF-alpha was not found in serum during the course of Listeria infection. In contrast to bacterial meningitis, no TNF-alpha was detected at any time in CSF of mice suffering from severe lymphocytic choriomeningitis induced by intracerebral infection with lymphocytic choriomeningitis virus. This difference is striking since both model infections led to a massive infiltration of polymorphonuclear and mononuclear leukocytes into the meninges and CSF. The results found for the two model infections were paralleled by findings in humans; CSF from three out of three patients with bacterial meningitis examined during the first day of hospitalization showed significant levels of TNF-alpha; none of the CSF obtained later than 3 d after hospitalization was positive. In addition, similarly to what was found in mice with viral meningitis, zero out of seven patients with viral meningitis had detectable TNF-alpha in CSF.

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