Cerebrospinal Fluid Analysis in Systemically Ill Children Without Central Nervous System Disease

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 48-51
Author(s):  
Carol Carraccio ◽  
Krystyna Blotny ◽  
Margaret C. Fisher
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Blood Cell ◽  
Neutrophil Count ◽  
Cns Infection ◽  
Blood Cell Count ◽  
Diagnostic Categories ◽  
Close Proximity ◽  
Focus Of Infection

Objective. Experience led us to question the applicability of standards for normal cerebrospinal fluid (CSF), originally developed in healthy children, to children with systemic illness but without central nervous system (CNS) infection. The purpose of this study was to test our hypothesis that systemically ill children, in the absence of CNS infection, have an elevated CSF white blood cell count and a greater percentage of neutrophils than accepted norms. Methods. We enrolled 345 patients in the following diagnostic categories: infants 1 month of age or younger with possible sepsis (n = 95), patients older than 1 month of age with possible sepsis (n = 155), patients with a focus of infection in close proximity to the CNS (n = 51), and patients presenting with seizures and fevers (n = 45). Sociodemographic data and results of CSF examination were abstracted from the medical records. Statistical analysis systems were used for data processing. Results. The CSF white blood cell count did not significantly differ from standards except for a lower mean count in the group presenting with seizures. The percent of CSF neutrophils was significantly greater than standards, however, for those patients older than 1 month of age with possible sepsis, those with a focus of infection in close proximity to the CNS, and those presenting with seizures. Data analysis by quantiles shows only 25% to 50% of patients, in each of the diagnostic categories, meeting the current definition of normal CSF neutrophil count. Conclusions. Our results show that a mean of at least 5% neutrophils may be present in the CSF with a diagnosis of fever without a source, a focus of infection in close proximity to the CNS, or a seizure with fever in the absence of CNS infection. These data support tailoring treatment based on clinical assessment rather than what is considered an abnormal CSF neutrophil count by current standards.

scholarly journals When Ventricular Cerebrospinal Fluid Assessment Misleads: Basal Meningitis and the Importance of Lumbar Puncture Sampling

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Sadid F Khan ◽  
Thornton Macauley ◽  
Steven Y C Tong ◽  
Ouli Xie ◽  
Carly Hughes ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Lumbar Puncture ◽  
Cns Infection ◽  
Pathophysiological Mechanisms ◽  
Cns Infections ◽  
Fluid Assessment ◽  
Composition Gradients

Abstract The diagnosis of central nervous system (CNS) infection relies upon analysis of cerebrospinal fluid (CSF). We present 4 cases of CNS infections associated with basal meningitis and hydrocephalus with normal ventricular CSF but grossly abnormal lumbar CSF. We discuss CSF ventricular–lumbar composition gradients and putative pathophysiological mechanisms and highlight clinical clues for clinicians.

Central Nervous System Infections

2016 ◽  
Author(s):  
Nicholas J. Johnson ◽  
David F. Gaieski
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Cns Infection ◽  
Cns Infections ◽  
Associated Conditions

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections.   This review contains 8 highly rendered figures, 7 tables, and 94 references

scholarly journals Serum and cerebrospinal fluid neurofilament light chain in patients with central nervous system infections caused by varicella-zoster virus

2020 ◽  
Vol 26 (5) ◽  
pp. 719-726
Author(s):  
Tobias Tyrberg ◽  
Staffan Nilsson ◽  
Kaj Blennow ◽  
Henrik Zetterberg ◽  
Anna Grahn
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Light Chain ◽  
Cns Infection ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Varicella Zoster

Abstract Varicella-zoster virus (VZV) is a common cause of viral central nervous system (CNS) infection, and patients may suffer from severe neurological sequelae. The biomarker neurofilament light chain (NFL) is used for assessment of neuronal damage and is normally measured in cerebrospinal fluid (CSF). Novel methods have given the possibility to measure NFL in serum instead, which could be a convenient tool to estimate severity of disease and prognosis in VZV CNS infections. Here, we investigate the correlation of serum and CSF NFL in patients with VZV CNS infection and the association of NFL levels in serum and CSF with different VZV CNS entities. NFL in serum and CSF was measured in 61 patients who were retrospectively identified with neurological symptoms and VZV DNA in CSF detected by PCR. Thirty-three herpes zoster patients and 40 healthy blood donors served as control groups. NFL levels in serum and CSF correlated strongly in the patients with VZV CNS infection. Encephalitis was associated with significantly higher levels of NFL in both serum and CSF compared with meningitis and Ramsay Hunt syndrome. Surprisingly, herpes zoster controls had very high serum NFL levels, comparable with those shown in encephalitis patients. We show that analysis of serum NFL can be used instead of CSF NFL for estimation of neuronal injury in patients with VZV CNS infection. However, high levels of serum NFL also in patients with herpes zoster, without signs of CNS involvement, may complicate the interpretation.

scholarly journals A Comparison of SAA Levels in Children With Viral CNS Infection and Kawasaki’s Disease

2020 ◽  
Author(s):  
Hui Yang ◽  
Ran Huo
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Systemic Vasculitis ◽  
Cns Infection ◽  
Chi Square ◽  
Chi Square Test ◽  
Kawasaki’S Disease ◽  
High Level ◽  
Kawasaki's Disease

Abstract Background: The purpose of this study was to analyze the epidemiological differences of SAA in children with viral central nervous system (CNS) infection and Kawasaki’s Disease(KD). The former is viral invasion of central nervous system, whereas the latter is a viral systemic vasculitis. Differences in the SAA concentration in the blood and the proportion of high level SAA cases reflected the influence of the blood-cerebrospinal fluid barrier (BCB) on the concentration of peripheral blood infection markers.Methods: The SAA data comprised 226 consecutive cases of children, including 112 cases of viral CNS infection and 114 cases of KD. Differences in the proportion and concentration of SAA in the cases of the two groups were verified with a Kruskal-Wallis H-test and the chi-square test.Results: The concentration of SAA differed between children with KD and viral CNS infection, and the high level SAA proportion was lower in children with viral CNS infection compared to that in the KD group.Conclusions: The observed differences may be due to the sequestration effect, as the blood-cerebrospinal fluid barrier (BCB) can compartmentalize the pathogens at the site of disease. Therefore, other organs are unable to be stimulated to release additional SAA.

scholarly journals Community-acquired Klebsiella pneumoniae central nervous infection with acute suppurative otitis and bacteremia: a case report in mainland China

2020 ◽  
Author(s):  
Ruixue Sun ◽  
Hui Zhang ◽  
Yingchun Xu ◽  
Huadong Zhu ◽  
Xuezhong Yu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mainland China ◽  
Supportive Therapy ◽  
Cns Infection ◽  
Intracranial Lesion ◽  
Infection Focus ◽  
Intracranial Lesions ◽  
Brain Abscesses

Abstract Community-acquiredKlebsiella pneumoniae (K. pneumoniae) central nervous system (CNS) infection combined with bacteremia was rarely identified world. We received a 55-year-old womanwho was under hormone therapy because of Sjogren's syndrome.The onset of this case was acute suppurative otitis,then she developed headache and unconscious, the cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae meningitis and suspicious brain abscesses, and K. pneumoniae bacteremia was also combined. Even with adequate antibiotic and supportive therapy, the patient’ relatives refused further assessment of intracranial lesions and took the patient back home, finally the patient died of no spontaneous breathing.Hormone therapy might be the risk factor of community-acquiredK. pneumoniaeinfection. Appropriate antibiotic application and infection focus drainage should be tried for treating this condition. The reason of patient’s death might be the CNS infection combined with K. pneumoniaebacteremia and the absence of intracranial lesion elimination. This case is reported in order to help us know this rare disease and promote a further progress on its pathogenesis and treatment.

scholarly journals Evaluation of the Mtb72F Polyprotein Vaccine in a Rabbit Model of Tuberculous Meningitis

2006 ◽  
Vol 74 (4) ◽  
pp. 2392-2401 ◽  
Author(s):  
Liana Tsenova ◽  
Ryhor Harbacheuski ◽  
Andre L. Moreira ◽  
Evette Ellison ◽  
Wilfried Dalemans ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Weight Loss ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Mycobacterium Tuberculosis ◽  
Tuberculous Meningitis ◽  
Protective Efficacy ◽  
Rabbit Model ◽  
Cns Infection ◽  
The Brain

ABSTRACT Using a rabbit model of tuberculous meningitis, we evaluated the protective efficacy of vaccination with the recombinant polyprotein Mtb72F, which is formulated in two alternative adjuvants, AS02A and AS01B, and compared this to vaccination with Mycobacterium bovis bacillus Calmette-Guérin (BCG) alone or as a BCG prime/Mtb72F-boost regimen. Vaccination with Mtb72F formulated in AS02A (Mtb72F+AS02A) or Mtb72F formulated in AS01B (Mtb72F+AS01B) was protective against central nervous system (CNS) challenge with Mycobacterium tuberculosis H37Rv to an extent comparable to that of vaccination with BCG. Similar accelerated clearances of bacilli from the cerebrospinal fluid, reduced leukocytosis, and less pathology of the brain and lungs were noted. Weight loss of infected rabbits was less extensive for Mtb72F+AS02A-vaccinated rabbits. In addition, protection against M. tuberculosis H37Rv CNS infection afforded by BCG/Mtb72F in a prime-boost strategy was similar to that by BCG alone. Interestingly, Mtb72F+AS01B induced better protection against leukocytosis and weight loss, suggesting that the polyprotein in this adjuvant may boost immunity without exacerbating inflammation in previously BCG-vaccinated individuals.

scholarly journals 1399. A Prospective Cohort Study Regarding the Impact of Biofire® FilmArray® Meningitis/Encephalitis (FA) Panel in Children with Suspected Central Nervous System Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S509-S509
Author(s):  
Lamprini Posnakoglou ◽  
Vasiliki Syriopoulou ◽  
Tania Siahanidou ◽  
Eleni Atmatzidou ◽  
Triantafyllos Syriopoulos ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Cohort Study ◽  
Aseptic Meningitis ◽  
Prospective Cohort ◽  
Cns Infection ◽  
Control Group ◽  
Total Cost ◽  
Hospitalization Cost

Abstract Background Rapid detection of pathogens involved in central nervous system (CNS) infections could be important for the optimal patient management and overall hospitalization cost. The aim of the study was to evaluate the possible benefits with the use of BioFire® FilmArray® meningitis/encephalitis (FA) panel in children with suspected CNS infection. Methods A prospective cohort study, was performed on children admitted to a tertiary pediatric hospital, over a period of 1 year (April 2018–April 2019), with possible CNS infection and cerebrospinal fluid (CSF) pleocytosis (>15 cells/mm3). For each child that FA was used for the diagnosis, an age-matched control was selected, and separate molecular CSF microbiological tests were sent according to pediatrician’s discretion. Conventional microbiological procedures were performed in all children. Length of hospital stay, duration of antimicrobials, and total cost of hospitalization were compared between groups. FA enables rapid automated cerebrospinal fluid testing for 14 common viral, bacterial and yeast pathogens that cause CNS infections. The cost was estimated according to ICD-10 diagnosis standard cost, adding additional daily hospitalization cost, FA or other molecular microbiological tests costs. Results A total of 142 children were included in the study (71 cases). The median age of cases and controls was 2.5 months (IQR: 1–72) and 2 months (IQR: 0.7–36) respectively (P = 0.157). A pathogen was detected in 38/71 (53.5%) children with the use of FA and in 16/71 (22.5%) in the control group (P < 0.001). In aseptic meningitis cases a virus was detected in 27/60 (45%) and in 11/64 (16.4%) controls (P < 0.001). Length of stay in cases and controls with aseptic meningitis was 5 days (IQR: 4–8) and 8 (IQR: 6–10) respectively (P < 0.001). The median duration of antimicrobials in cases was 4 days (IQR: 2–5.7) and 7 (IQR: 5–10) respectively (P < 0.001). The hospitalization cost was calculated in cases and controls 1,042 (IQR: 932–1372€) and 1,522 (IQR: 1,302–1,742€) respectively (P < 0.001). Conclusion The use of FA was able to reduce significantly the hospitalization days and the total cost comparing to the control group in children with suspected CNS infection. Disclosures All authors: No reported disclosures.

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