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Cerebrospinal fluid lymphocytosis in acute bacterial meningitis
Abstract:
Cerebrospinal fluid lymphocytosis (more than 50 percent lymphocytes or mononuclear cells) occurred in 14 of 103 cases of bacteriologically proved acute bacterial meningitis. Patients with cerebrospinal fluid lymphocytosis accounted for 32 percent (13 of 41) of all patients with bacterial meningitis with a cerebrospinal fluid white blood cell concentration of 1,000/mm3 or less. Cerebrospinal fluid lymphocytosis was significantly more common in neonates and in those without meningismus, but occurred in all ages and without any clear identifying clinical characteristics. The most common etiologic organisms were Streptococcus pneumonia (five), Neisseria meningitidis (two), and Hemophilus influenzae (two). Cerebrospinal fluid lymphocytosis is common in acute bacterial meningitis when the cerebrospinal fluid white blood cell concentration is below 1,000/mm3. It is therefore of little value in differentiating bacterial meningitis from viral, fungal, and tuberculous meningitis.
Insights
Cerebrospinal fluid lymphocytosis, a high lymphocyte count in spinal fluid, is common in bacterial meningitis, especially with low white blood cell counts. This finding is not useful for distinguishing bacterial meningitis from other types like viral or fungal infections.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Microbiology
Background:
- Cerebrospinal fluid (CSF) analysis is crucial for diagnosing meningitis.
- Distinguishing between bacterial and other forms of meningitis (viral, fungal, tuberculous) is clinically important.
- Lymphocytosis in CSF typically suggests non-bacterial causes, but this study investigates its occurrence in bacterial meningitis.
Purpose of the Study:
- To determine the frequency and significance of cerebrospinal fluid lymphocytosis in acute bacterial meningitis.
- To assess the utility of CSF lymphocytosis in differentiating bacterial meningitis from other etiologies.
Main Methods:
- Retrospective analysis of 103 cases with bacteriologically confirmed acute bacterial meningitis.
- Evaluation of CSF parameters, including white blood cell count and differential, in relation to clinical presentation.
- Correlation of CSF findings with specific bacterial pathogens identified.
Main Results:
- Cerebrospinal fluid lymphocytosis ( >50% lymphocytes) was observed in 14% (14/103) of bacterial meningitis cases.
- This finding was more prevalent (32%, 13/41) in patients with CSF white blood cell counts ≤1,000/mm³.
- Lymphocytosis was more common in neonates and those without meningismus, but lacked specific clinical identifiers.
Conclusions:
- Cerebrospinal fluid lymphocytosis is a relatively common finding in acute bacterial meningitis, particularly when CSF white blood cell counts are low.
- The presence of CSF lymphocytosis in bacterial meningitis limits its value as a sole diagnostic marker for differentiating bacterial from viral, fungal, or tuberculous meningitis.