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Pleocytosis is not fully responsible for low CSF glucose in meningitis

Maxime O Baud1, Jeffrey R Vitt1, Nathaniel M Robbins1

  • 1Department of Neurology (M.O.B., J.R.V., N.M.R., M.R.W., F.C.C., J.M.G., S.A.J.) and Department of Laboratory Medicine (S.M.), University of California, San Francisco; and Department of Neurology (R.W.), University of Michigan, Ann Arbor. N.M.R. is currently affiliated with the Department of Neurology, Dartmouth Geisel School of Medicine.

Neurology(R) Neuroimmunology & Neuroinflammation
|January 4, 2018
PubMed
Abstract

Insights

Low cerebrospinal fluid (CSF) glucose in meningitis is driven by inflammation and protein levels, particularly in microbial cases. CSF glucose and CSF-to-serum glucose ratios aid in diagnosing microbial meningitis.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Clinical Chemistry

Background:

  • Hypoglycorrhachia, or low cerebrospinal fluid (CSF) glucose, is a known complication of meningitis, but its underlying mechanisms remain unclear.
  • The relative contributions of inflammatory processes within the CSF and the presence of microorganisms to CSF glucose reduction are not well understood.

Purpose of the Study:

  • To investigate the factors contributing to hypoglycorrhachia in meningitis.
  • To differentiate the roles of CSF inflammation and microbial presence in lowering CSF glucose levels.
  • To evaluate the diagnostic utility of CSF glucose and CSF-to-serum glucose ratios for microbial meningitis.

Main Methods:

  • Retrospective analysis of CSF profiles from patients with microbial and aseptic meningitis.
  • Assessment of CSF leukocyte count, glucose, and protein concentrations.
  • Application of multivariate and stratified linear regression to analyze marker relationships.
  • Calculation of receiver operating characteristics for CSF glucose and CSF-to-serum glucose ratios.

Main Results:

  • Increasing CSF inflammation correlated with decreased CSF glucose in microbial meningitis, but not in aseptic meningitis.
  • Elevated CSF protein levels showed a stronger association with low CSF glucose than leukocyte count.
  • Hypoglycorrhachia was significantly more prevalent in microbial meningitis (50.1%) compared to aseptic cases (9.6%), with neurosarcoidosis being a notable exception.
  • CSF glucose and CSF-to-serum glucose ratios demonstrated moderate-to-high specificity for diagnosing microbial meningitis.

Conclusions:

  • The primary cause of hypoglycorrhachia in meningitis is a combination of microbial presence and significant CSF inflammation with elevated protein levels.
  • Microorganisms capable of metabolizing glucose are key determinants of hypoglycorrhachia, except in conditions like neurosarcoidosis.
  • Low CSF glucose and CSF-to-serum glucose ratios are valuable diagnostic markers for identifying microbial meningitis.

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