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Dilemma in Diagnosis of Pyogenic Meningitis in Cerebrospinal Fluid Contaminated with Blood: Does Leucocyte Esterase

Vani Krishnamurthy1, Nidha Nabil1, Swathi Muni Reddy1

  • 1Department of Pathology, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.

Journal of Cytology
|February 13, 2019
PubMed
Abstract

Insights

The leucocyte esterase strip accurately identifies pyogenic meningitis by detecting activated neutrophils in cerebrospinal fluid (CSF). This test effectively distinguishes between true infection and blood contamination during lumbar puncture.

Area of Science:

  • Clinical diagnostics
  • Infectious disease pathology
  • Cerebrospinal fluid analysis

Background:

  • Pyogenic meningitis is a severe condition diagnosed via cerebrospinal fluid (CSF) analysis.
  • Lumbar puncture (LP) can contaminate CSF with peripheral blood leukocytes, compromising cytological analysis.
  • Leukocyte esterase strips detect inflammation in various body fluids.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of leukocyte esterase strips in differentiating pyogenic meningitis from blood-contaminated CSF.
  • To compare the leukocyte esterase test's ability to distinguish between inflammatory and circulating neutrophils in CSF.

Main Methods:

  • A prospective analytical study was conducted in a tertiary care hospital.
  • CSF samples from pyogenic meningitis patients were tested for leukocyte esterase activity.
  • Normal CSF samples were experimentally contaminated with buffy coat, and leukocyte esterase activity was measured.

Main Results:

  • The leukocyte esterase dipstick demonstrated an overall sensitivity of 81% and specificity of 99% for diagnosing pyogenic meningitis.
  • A 2+ reading on the strip showed 70% sensitivity and 100% specificity for pyogenic meningitis when compared to experimentally contaminated CSF.

Conclusions:

  • Leukocyte esterase strips are highly specific for detecting pyogenic meningitis.
  • The test can reliably differentiate between activated neutrophils at an inflammatory site and neutrophils from blood contamination in CSF.
Keywords:
Blood contaminationcerebrospinal fluidleucocyte esterasepyogenic meningitis

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